Potentially Preventable Mortality After Elective Colorectal Cancer Surgery: Insights From a National Surgical...

Colorectal cancer (CRC) is a significant contributor to preventable deaths worldwide. The assessment of potentially avoidable mortality following elective CRC surgery has yet to be reported. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) seeks to peer-review all deaths associated with surgical care. This study aims to determine the incidence of clinical management issues (CMIs) in potentially preventable deaths following elective CRC surgery.

ANZASM data from 2013 to 2023 were reviewed, and all in-hospital deaths following elective CRC surgery were selected for analysis. A predefined list of patient-care factors filled in by the treating surgeon and independent assessors was examined to identify CMIs. Deaths were categorized into two groups: potentially preventable and non-preventable.

A total of 243 patients died after elective CRC resection over the 10-year study period. Of these, 134 (55.1%) deaths were considered potentially preventable. Compared to the non-preventable group, patients with potentially preventable deaths had higher rates of overall intraoperative (15.7% vs. 3.7%) and postoperative complications (88.8% vs. 63.3%). Potentially preventable deaths also had a greater number of CMIs per patient [median (range): 2 (1-6) vs. 1 (0-3)], with higher CMI rates during preoperative (25.0% vs. 12.8%), intraoperative (32.6% vs. 3.7%) and postoperative (58.8% vs. 28.6%) phases of surgical care.

Over half of deaths following elective CRC surgery were potentially preventable. This study highlights deficiencies at all stages of surgical care and provides essential feedback to colorectal surgeons and healthcare professionals to further improve the safety and quality of care.