223. UNDERSTANDING POTENTIALLY PREVENTABLE MORTALITY FOLLOWING ESOPHAGO-GASTRIC CANCER SURGERY: ANALYSIS OF A NATIONAL AUDIT OF SURGICAL MORTALITY

Abstract

Abstract Introduction At a national level, understanding preventable mortality after esophago-gastric cancer surgery can direct quality-improvement efforts. Here, we utilized the Australian and New Zealand Audit of Surgical Mortality (ANZASM) database to 1) determine the causes of death following esophago-gastric cancer resections in Australia, 2) quantify the proportion of potentially preventable death, and 3) identify clinical management issues contributing to preventable mortality. Methods All in-hospital mortalities following esophago-gastric cancer surgery from 01/01/2010 to 31/12/2020 were analyzed from ANZASM data. Potentially preventable and non-preventable cases were compared. Thematic analysis was used classify clinical management issues. Overall, we reviewed 636 complications and 123 clinical management issues in 105 mortalities. Results The most common causes of death were cardio-respiratory in etiology. Forty-nine (46.7%) mortalities were potentially preventable. These cases were characterized by higher rates of sepsis (59.2% vs. 33.9%, p = 0.011), multiorgan dysfunction syndrome (40.8% vs. 25.0%, p = 0.042), reoperation (63.3% vs. 41.1%, p = 0.031), and other complications compared with non-preventable mortality. Potentially preventable mortalities also had more clinical management issues per patient [median (IQR): 2 (1–3) vs. 0 (0–1), p < 0.001), which adversely impacted preoperative (30.6% vs. 7.1%, p = 0.002), intraoperative (18.4% vs. 5.4%, p = 0.037), and postoperative (51.0% vs. 17.9%, p < 0.001) care. Thematic analysis highlighted recurrent areas of deficiency in patient management. Conclusions Almost 50% of deaths following esophago-gastric cancer resections were potentially preventable. These were characterized by higher complication rates and clinical management issues. We highlighted recurrent themes in patient management to improve future quality-of-care.