Ong Yi Long Roy, Sambrook Paul, Maddern Guy
Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Department of Oral and Maxillofacial Surgery, Adelaide Dental School, The University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2021 Jan;91(1-2):145-151. doi: 10.1111/ans.16463. Epub 2020 Nov 27.
Oral squamous cell carcinoma (OSCC) is a significant public health issue. Australia had 448 deaths from lip and oral cavity cancer in 2018, some of which could be prevented. Consideration of the factors contributing to mortality after OSCC resection can provide a greater insight into how deaths can be prevented.
This paper used data from the Australia and New Zealand Audit of Surgical Mortality from the last 10 years from 1 January 2009 to 31 December 2018 for analysis. All surgical deaths were captured as the treating surgeons were mandated to complete a surgical case form for assessment by an independent surgeon from the same specialty.
This study found 25 cases of death after OSCC resection. In 44% of cases, death was related to cardiac causes and 40% was related to respiratory causes. Fourteen cases were found to have issues with management, and 25 issues were raised. In 36% of issues, it was found to be related to decision to operate. There were no obvious differences between the patients who had neck dissections and those who did not.
The decision to operate on high-risk patients, cardiovascular and respiratory causes were the major contributors to surgical mortality. The small number of deaths and the limitation of using existing data limited statistical analysis and conclusions. Changes could be made to the Australia and New Zealand Audit of Surgical Mortality to improve the results for analysis.
口腔鳞状细胞癌（OSCC）是一个重大的公共卫生问题。2018年，澳大利亚有448人死于唇癌和口腔癌，其中一些死亡是可以预防的。考虑OSCC切除术后导致死亡的因素，有助于更深入了解如何预防死亡。
本文使用了2009年1月1日至2018年12月31日过去10年澳大利亚和新西兰外科手术死亡率审计的数据进行分析。所有手术死亡病例均被记录，因为主治外科医生必须填写一份手术病例表，由同专业的独立外科医生进行评估。
本研究发现25例OSCC切除术后死亡病例。在44%的病例中，死亡与心脏原因有关，40%与呼吸原因有关。发现14例存在管理问题，共提出25个问题。在36%的问题中，发现与手术决策有关。接受颈部清扫术的患者和未接受颈部清扫术的患者之间没有明显差异。
对高危患者的手术决策、心血管和呼吸原因是手术死亡率的主要因素。死亡病例数量较少以及现有数据的局限性限制了统计分析和结论。可以对澳大利亚和新西兰外科手术死亡率审计进行改进，以提高分析结果。
