Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends
Objectives In this manuscript, we describe broad trends in postoperative mortality in New Zealand (a country with universal healthcare) for acute and elective/waiting list procedures conducted between 2005 and 2017.Design, participants and setting We use high-quality national-level hospitalisation d...
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BMJ Publishing Group
2020-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/10/9/e036451.full |
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| author | James Stanley Sarah Jackson Jason K Gurney Melissa McLeod Doug Campbell Luke Boyle Elizabeth Dennett Jonathan Koea Dick Ongley Diana Sarfati |
| author_facet | James Stanley Sarah Jackson Jason K Gurney Melissa McLeod Doug Campbell Luke Boyle Elizabeth Dennett Jonathan Koea Dick Ongley Diana Sarfati |
| author_sort | James Stanley |
| collection | DOAJ |
| description | Objectives In this manuscript, we describe broad trends in postoperative mortality in New Zealand (a country with universal healthcare) for acute and elective/waiting list procedures conducted between 2005 and 2017.Design, participants and setting We use high-quality national-level hospitalisation data to compare the risk of postoperative mortality between demographic subgroups after adjusting for key patient-level confounders and mediators. We also present temporal trends and consider how rates in postoperative death following acute and elective/waiting list procedures have changed over this time period.Results and conclusion A total of 1 836 683 unique patients accounted for 3 117 374 admissions in which a procedure was performed under general anaesthetic over the study period. We observed an overall 30-day mortality rate of 0.5 per 100 procedures and a 90-day mortality rate of 0.9 per 100. For acute procedures, we observed a 30-day mortality rate of 1.6 per 100, compared with 0.2 per 100 for elective/waiting list procedures. In terms of procedure specialty, respiratory and cardiovascular procedures had the highest rate of 30-day mortality (age-standardised rate, acute procedures: 3–6 per 100; elective/waiting list: 0.7-1 per 100). As in other contexts, we observed that the likelihood of postoperative death was not proportionally distributed within our population: older patients, Māori patients, those living in areas with higher deprivation and those with comorbidity were at increased risk of postoperative death, even after adjusting for all available factors that might explain differences between these groups. Increasing procedure risk (measured using the Johns Hopkins Surgical Risk Classification System) was also associated with an increased risk of postoperative death. Encouragingly, it appears that risk of postoperative mortality has declined over the past decade, possibly reflecting improvements in perioperative quality of care; however, this decline did not occur equally across procedure specialties. |
| format | Article |
| id | doaj-art-e9d09ff69d28455d826a819ce05eb196 |
| institution | DOAJ |
| issn | 2044-6055 |
| language | English |
| publishDate | 2020-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e9d09ff69d28455d826a819ce05eb1962025-08-20T02:44:20ZengBMJ Publishing GroupBMJ Open2044-60552020-09-0110910.1136/bmjopen-2019-036451Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trendsJames Stanley0Sarah Jackson1Jason K Gurney2Melissa McLeod3Doug Campbell4Luke Boyle5Elizabeth Dennett6Jonathan Koea7Dick Ongley8Diana Sarfati9Department of Public Health, University of Otago, Wellington, New ZealandDepartment of Behavioural Science and Health, University College London, London, UKDepartment of Public Health, School of Medicine, University of Otago, Wellington, New ZealandTe Rōpū Rangahau Hauora a Eru Pōmare, University of Otago Wellington, Wellington, New ZealandDepartment of Anaesthesia and Perioperative Medicine, Auckland DHB Anaesthesia, Auckland District Health Board, Auckland, New Zealand2University of Auckland, Auckland, NZDepartment of General Surgery, Capital and Coast District Health Board, Wellington, New ZealandDepartment of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New ZealandDepartment of Anaesthesia, Canterbury District Health Board, Christchurch, New Zealand2 Te Aho o Te Kahu - Cancer Control Agency, Wellington, New ZealandObjectives In this manuscript, we describe broad trends in postoperative mortality in New Zealand (a country with universal healthcare) for acute and elective/waiting list procedures conducted between 2005 and 2017.Design, participants and setting We use high-quality national-level hospitalisation data to compare the risk of postoperative mortality between demographic subgroups after adjusting for key patient-level confounders and mediators. We also present temporal trends and consider how rates in postoperative death following acute and elective/waiting list procedures have changed over this time period.Results and conclusion A total of 1 836 683 unique patients accounted for 3 117 374 admissions in which a procedure was performed under general anaesthetic over the study period. We observed an overall 30-day mortality rate of 0.5 per 100 procedures and a 90-day mortality rate of 0.9 per 100. For acute procedures, we observed a 30-day mortality rate of 1.6 per 100, compared with 0.2 per 100 for elective/waiting list procedures. In terms of procedure specialty, respiratory and cardiovascular procedures had the highest rate of 30-day mortality (age-standardised rate, acute procedures: 3–6 per 100; elective/waiting list: 0.7-1 per 100). As in other contexts, we observed that the likelihood of postoperative death was not proportionally distributed within our population: older patients, Māori patients, those living in areas with higher deprivation and those with comorbidity were at increased risk of postoperative death, even after adjusting for all available factors that might explain differences between these groups. Increasing procedure risk (measured using the Johns Hopkins Surgical Risk Classification System) was also associated with an increased risk of postoperative death. Encouragingly, it appears that risk of postoperative mortality has declined over the past decade, possibly reflecting improvements in perioperative quality of care; however, this decline did not occur equally across procedure specialties.https://bmjopen.bmj.com/content/10/9/e036451.full |
| spellingShingle | James Stanley Sarah Jackson Jason K Gurney Melissa McLeod Doug Campbell Luke Boyle Elizabeth Dennett Jonathan Koea Dick Ongley Diana Sarfati Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends BMJ Open |
| title | Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends |
| title_full | Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends |
| title_fullStr | Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends |
| title_full_unstemmed | Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends |
| title_short | Postoperative mortality in New Zealand following general anaesthetic: demographic patterns and temporal trends |
| title_sort | postoperative mortality in new zealand following general anaesthetic demographic patterns and temporal trends |
| url | https://bmjopen.bmj.com/content/10/9/e036451.full |
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