Royal Australasian College of Surgeons, Morbidity Audits, Research, Audit & Academic Surgery, Adelaide, South Australia, Australia.
Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth, Western Australia, Australia.
Br J Surg. 2023 Sep 6;110(10):1367-1373. doi: 10.1093/bjs/znad200.
Australia's unique national surgical mortality audit has had a long-term focus on the avoidance of futile surgery. The 30-day mortality rate after emergency laparotomy in Australia is lower than in other countries. Early death (within 72 h) after emergency laparotomy may reflect futile surgery. This paper considers whether Australia's national mortality audit is the reason for its lower mortality rate after emergency laparotomy.
Data were extracted from the Australia and New Zealand Emergency Laparotomy Audit-Quality Improvement (ANZELA-QI) from 2018 to 2022. The time elapsed from emergency laparotomy to death was determined for each patient. The cumulative daily mortality rate was calculated for the first 30 days and expressed as a proportion of all emergency laparotomies, and 30-day and in-hospital mortality. Mortality data were compared with those in the only three similar overseas studies. The mortality rate after emergency laparotomy for patients who required but did not undergo surgery was calculated for each hospital. The proportion of patients with high-risk characteristics was compared with that in the National Emergency Laparotomy Audit (NELA).
Compared with overseas studies, there was a lower early (within 72 h) mortality rate in ANZELA-QI. Although the lower mortality rate in ANZELA-QI persisted to 30 days, there was a relative increase after 14 days that likely reflected known poor compliance with care standards. Australian patients had fewer high-risk characteristics than those in NELA.
The present findings support the hypothesis that the lower mortality rate after emergency laparotomy in Australia is likely a consequence of its national mortality audit and the avoidance of futile surgery.
澳大利亚独特的国家外科手术死亡率审计长期以来一直关注避免无效手术。澳大利亚急诊剖腹手术后 30 天的死亡率低于其他国家。急诊剖腹手术后早期（72 小时内）死亡可能反映了无效手术。本文探讨了澳大利亚国家死亡率审计是否是其急诊剖腹手术后死亡率较低的原因。
从 2018 年至 2022 年的澳大利亚和新西兰急诊剖腹手术审计质量改进（ANZELA-QI）中提取数据。确定每位患者从急诊剖腹手术到死亡的时间间隔。计算前 30 天的累积每日死亡率，并表示为所有急诊剖腹手术、30 天和住院死亡率的比例。将死亡率数据与仅有的三项类似海外研究进行比较。计算每个医院需要但未接受手术的患者的急诊剖腹手术后死亡率。将具有高危特征的患者比例与国家急诊剖腹手术审计（NELA）进行比较。
与海外研究相比，ANZELA-QI 的早期（72 小时内）死亡率较低。尽管 ANZELA-QI 的较低死亡率持续到 30 天，但在 14 天后相对增加，这可能反映了已知的不符合护理标准的情况。澳大利亚患者的高危特征比 NELA 中的患者少。
本研究结果支持这样一种假设，即澳大利亚急诊剖腹手术后死亡率较低可能是由于其国家死亡率审计和避免无效手术所致。
