title: Perioperative Mortality Rates in Australian Public Hospitals: The Influence of Age, Gender and Urgency.
abstract: A decline in surgical deaths has been observed in Australia since the introduction of the Australian and New Zealand Audit of Surgical Mortality (ANZASM). The current study was conducted to determine whether the perioperative mortality rate (POMR) has also declined.
  
  
  
  This study is a retrospective review of the POMR for surgical procedures in Australian public hospitals between July 2009 and June 2013, using data obtained from the Australian Institute of Health and Welfare. Operative procedures contained in the Australian Refined Diagnosis Related Groups were selected and the POMR was modelled using urgency of admission, age and gender as explanatory covariates.
  
  
  
  The POMR in Australian public hospitals reduced by 15.4 % over the 4-year period. The emergency admissions POMR dropped from 1.40 to 1.12 %, and the elective admissions POMR from 0.09 to 0.08 %. The binary logistic regression model used to predict patient mortality showed emergency admissions to have a higher POMR than elective, being more evident at older ages. For emergency admissions, the difference in POMR between females and males increased with age, from about 55 years onwards, with females being lower. For elective surgeries, the difference between males and females was of little practical importance across ages.
  
  
  
  The reduction in the POMR in Australia confirms the reduction in surgical deaths reported to ANZASM. Continuing to monitor POMR will be important to ensure the safest surgery in Australia. Further investigations into case-mix will allow better risk adjustment and comparison between regions and time-periods, to facilitate continuous quality improvement.
authors.affiliation: Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia. watters.david@gmail.com.|Deakin University, Barwon Health, Bellerine St, Geelong, VIC, 3220, Australia. watters.david@gmail.com.
authors.forename: David A
authors.initials: DA
authors.lastname: Watters
authors.affiliation: Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia.|Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Babidge
authors.affiliation: Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia.|Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Andreas
authors.initials: A
authors.lastname: Kiermeier
authors.affiliation: Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia.
authors.forename: Glenn A J
authors.initials: GA
authors.lastname: McCulloch
authors.affiliation: Research, Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Spring St, Melbourne, VIC, 3000, Australia.|Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Maddern
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002675:Child, Preschool; D017558:Elective Surgical Procedures / Q000401:mortality* / Q000639:trends; D004638:Emergency Treatment / Q000401:mortality* / Q000639:trends; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D012737:Sex Factors