A morbidity/mortality analysis of a tertiary level upper gastrointestinal/hepatopancreaticobiliary surgical unit
Susrutha K Wickremesekera1, Ho Beom Sean Seo2, Mary Anne Trimber3
1UGI/HPB and General Surgeon, Department of General Surgery, Wellington Hospital, Wellington.
Internationally, regionalisation of major upper gastrointestinal/hepatopancreaticobiliary (UGI/HPB) surgery to a selected number of expert hospital centres has demonstrated that high hospital volume is associated with lower mortality and morbidity. The Wellington UGI/HPB unit compared to international institutions is a low volume unit, however within New Zealand we perform a high number of Upper GI/HPB cases.
Internationally, regionalisation of major upper gastrointestinal/hepatopancreaticobiliary (UGI/HPB) surgery to a selected number of expert hospital centres has demonstrated that high hospital volume is associated with lower mortality and morbidity. The Wellington UGI/HPB unit compared to international institutions is a low volume unit, however within New Zealand we perform a high number of Upper GI/HPB cases.
Aims:
The aim of this study was to evaluate the quality measures of morbidity and mortality of major upper gastrointestinal and hepatopancreatobiliary surgeries performed at the Wellington UGI/HPB unit.
Methods:
An analysis was conducted to evaluate the major UGI/HBP surgeries performed at Wellington over a six-year period. Patient demographics, and morbidity and mortality were stratified using the Clavien-Dindo classification of surgical complications.
Results:
Three hundred and twenty-nine major elective cases were performed at the Wellington UGI/HPB unit over the six-year period. Sixty-five percent of patients experienced no morbidity, 19% of patients experienced mild morbidity, which had little effect on recovery, 14% of patients experienced major morbidity and 0.6% (two cases) progressed to mortality. When major UGI/HPB resections were specifically analysed, there were a total of 184 patients with 42 major morbidity (22.8%) and two mortalities (1.1%).
Conclusion:
Compared with international standards, the Wellington UGI/HPB unit is a low volume centre but has delivered an acceptable quality of care with a low major morbidity and mortality for this type of surgery.
