EXECUTIVE SUMMARY

Overview

The Northern Territory Audit of Surgical Mortality (NTASM) is an external, independent, peer-reviewed audit of care processes associated with surgical deaths in the Northern Territory (NT). NTASM has qualified privilege protection under Commonwealth legislation (gazetted 24 April 2022).

The purpose of NTASM is to provide feedback to inform, educate, facilitate change and improve practice. Surgeons are encouraged to use NTASM feedback to self-reflect and improve their practice. Hospitals and policy makers are encouraged to use NTASM feedback to develop strategies to address clinical management areas needing improvement and staffing gaps in the NT surgical workforce.

This report covers the period 1 July 2017 to 30 June 2022 (census date of 10 October 2022).

NORTHERN TERRITORY BASELINE DATA (1 JANUARY TO 31 DECEMBER 2021)

In section 9 of this report, NT baseline data (all patients admitted to NT public hospitals who had an operation or surgical procedure performed by a surgeon) are compared with NTASM data (in-hospital surgical deaths where a surgeon was responsible for, or had significant involvement in, the patient’s care, regardless of whether an operation was performed or not).

NT baseline data are provided by the NT Government Department of Corporate and Digital Development Data Services, Health Reporting and Analytics Team (approval number DMSR 13143).

Hospitals

All NT hospitals participate in NTASM.

Surgeons

All surgeons in the NT participate in NTASM.

A consultant surgeon was present for 82.5% (420/509) of operations.

Patients

By the census date, 431 patient deaths had occurred and 83.3% (359/431) reviews were completed.

57.1% (205/359) of patients were male.

88.6% (318/359) of patients had at least one comorbidity.

In patients with comorbidities, cardiovascular disease (65.8%; 208/316) was most frequently documented.

Aboriginal And Torres Strait Islander People

Aboriginal and Torres Strait Islander patients comprised 35.7% (128/359) of NTASM surgical deaths.

Compared with non-Indigenous patients, NTASM Aboriginal and Torres Strait Islander patients were more likely to be younger, require transfer, experience delays in diagnosis, acquire infections in the community and have more comorbidities (including diabetes and renal disease).

Operations Conducted

83.8% (301/359) of patients had an operation.

29.9% (90/301) of patients who had an operation had more than one operation.

Clinical Management Issues

Assessors considered that most patients (84.7%; 304/359) had no clinical management issues (CMIs) and 55 patients had CMIs (15.3%; 55/359).

Of all CMIs, 60.0% (33/55) were areas of consideration; 23.6% (13/55) were areas of concern and 16.4% (9/55) were adverse events.

Of all CMIs, 60.0% (33/55) were considered definitely or probably preventable.

Of the areas of consideration, 60.6% (20/33) of CMIs made no difference to the outcome.

Of the areas of concern, 76.9% (10/13) of CMIs may have contributed to the outcome.

Of the adverse events, 55.6% (5/9) of CMIs caused the death of the patient.

POSTOPERATIVE COMPLICATIONS

24.1% (72/299) of patients had a postoperative complication in the audit period (1 July 2017 to 30 June 2022).

POSTOPERATIVE INTENSIVE CARE UNIT USE

21% (63/300) of patients had an unplanned postoperative admission to an intensive care unit (ICU).

INFECTION

34.2% (122/357) of patients had an infection.

52.1% (63/121) of patients acquired the infection before admission. Of the infections acquired during admission, pneumonia was the most common.

TRAUMA

23.4% (84/359) of patients had experienced trauma.

The most frequent causes of trauma were falls (60.7%; 51/84), road traffic incidents (21.4%; 18/84) or violence (13.1%; 11/84).

Comparison Of Audit Data Between Financial Years

An executive summary comparison of NTASM audit data is shown in Table 1. The number of cases notified to NTASM, and elective admissions are decreasing. Emergency admissions and interhospital transfers are increasing. More than 80.0% of patients each year had an operation.

NTASM data demonstrates a number of improvements. Postoperative complications are decreasing despite the surgeon’s perceived risk of death for these patients increasing. Assessors have noted fewer areas of concern and adverse events and have requested fewer second-line assessments.