Elderly ‘at risk’ after surgery

The majority of deaths during or immediately after surgery involved elderly patients, according to an annual audit, while a campaign for a public register of surgeons’ performances in Australia continues to hit hurdles.

State-by-state audits are released every year by the Royal Australian College of Surgeons (RACS), with the latest, reporting on surgical deaths in Victoria, attributing most to elderly patients with underlying health problems and who were admitted in emergency situations.

In the past financial year, 805 clinical reviews were conducted in Victoria in cases where patients died while under the care of a surgeon, the audit reported.

“The actual cause of death was often non-preventable and linked to their pre-existing health status,” it said.

The 2018 annual report also contains information on 8375 deaths reported over the past five years. Of these deaths, 5348 had gone through the audit process with the remaining cases still under review.

A British doctor says information on surgeons’ performance in the UK has been publicly available since 2014 and argues that there should be a similar system in Australia.

The surgeon ‘league tables’ were set up in the UK as a way of improving standards.

Surgeon performance is measured according to such things as patient survival rates and number of operations performed.

British cardiothoracic anaesthetist Andrew Klein argues that the tables offer patients and their families a valuable tool when selecting a surgeon.

“If it was my mother or my wife or any member of my family, I would want to know which hospital they are going to and details about the surgeon, including their patient mortality rates,” he told news.com.

“For the patient, if the surgeon has nothing to hide then it should be published because people ‘do fear death’.”

While supporting the annual audits, RACS was less enthusiastic about a register based on the UK model.

RACS president John Batten said he was open to greater transparency regarding surgeon performance, but stopped short of supporting league tables that would be publicly available.

He warned that careers would be destroyed under such a move.

“If you made that public, what would happen?” said Dr Batten. “That would be the end of that surgeon’s career.”

He also argued that league tables would drive up hospital waiting times and that identifying surgeons who were not meeting performance standards was the responsibility of the whole hospital system.

A recent RACS national report made specific recommendations in relation to surgical risks for the elderly.

It said: “The patient should be transferred to a medical unit if very frail, elderly, high risk, and if medical issues are assessed as being the prominent clinical factor during the admission episode, providing that the surgical post-operative care can be performed appropriately in that setting.

“Time delays are to be minimised, particularly for elderly frail patients transferred between hospitals due to their limited physiological reserves. Time delays for these patients can significantly affect surgical outcomes.”

Would you like to see a public register of surgeons set up in Australia? Are you confident in the current system of referrals?

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Written by Janelle Ward

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