Chairman’s Report

This Case Note Review booklet highlights the difficulties faced in many environments of delayed surgery. Delay can be due to many factors: a delayed diagnosis, delays associated with transfer, inefficient management of patients through the hospital system, and slow assessment and action by the surgical team, to name but a few. The cases highlighted within this series would, in some cases, have made no difference to the outcome even if they had been rapidly managed. Nonetheless, the lessons to be learnt are that, despite this, surgical engagement and appropriate diagnosis has led to delays which could have been avoided. Even when procedures are finally conducted, on a number of occasions the lack of consultant engagement was certainly difficult to understand and probably unacceptable. The need to act in a timely fashion, particularly in cases of cardiac compromise, viscous perforation and contained infection, do require rapid management. Hospitals do need appropriate staffing so this can occur, but also the surgical team needs to be aware that delays can be fatal. I hope that this National Case Note Review booklet brings home some of these issues that we should all be aware of and constantly alert to. As always, we would welcome any constructive feedback or comments as a result of these cases.

Guy Maddern

Chairman, Australian and New Zealand Audit of Surgical Mortality (ANZASM)