Potentially-Preventable Deaths Following Colorectal Surgery: A National Retrospective Cohort Study of Surgical...

Many deaths after colorectal resection may be preventable, but administrative datasets provide limited insights into the clinical processes leading to mortality. We used the Australian and New Zealand Audit of Surgical Mortality (ANZASM) to quantify potentially preventable deaths after colorectal surgery and describe modifiable clinical management issues (CMI) in contemporary Australasian practice.

Retrospective cohort study of prospectively collected ANZASM data. Adults who died after elective or emergency colorectal resection between 2010 and 2023 were included. Potentially preventable mortality was defined as at least one CMI assessed as definitely or potentially preventable and contributing to death. CMIs were summarised by phase of care and thematically analysed.

Among 1058 deaths after colorectal resection, 321 (30.3%) were classified as potentially preventable. Potentially preventable deaths were more frequent after elective than emergency surgery (35.3 vs. 27.8%, p = 0.01). Leading causes of death were sepsis, multiorgan failure and aspiration/pneumonia. Anastomotic leak was the most common postoperative complication, implicated in 19.6% of deaths. Preventable mortality was independently associated with lower estimated operative risk, postoperative complications, unplanned ICU admission and rural hospital care. Common themes included suboptimal patient selection, physiological optimisation, anastomotic decision-making and delayed recognition or escalation of deterioration.

Nearly one third of audited deaths after colorectal surgery were potentially preventable, most arising from failures of selection, optimisation or rescue rather than technical errors. Strengthening preoperative triage, multidisciplinary decision-making and improving postoperative surveillance and escalation systems offer the greatest opportunities to reduce preventable mortality in colorectal surgery.