A morbidity/mortality analysis of a tertiary level upper gastrointestinal/hepatopancreaticobiliary surgical unit.
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.


OBJECTIVE
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%).


CONCLUSIONS
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.
UGI/HPB and General Surgeon, Department of General Surgery, Wellington Hospital, Wellington.
Susrutha K
SK
Wickremesekera
Registrar, Department of General Surgery, Wellington Hospital, Wellington.
Ho Beom Sean
HB
Seo
Registrar, Department of Vascular Surgery, Waikato Hospital, Hamilton.
Mary Anne
MA
Trimber
UGI and General Surgeon, Department of General Surgery, Wellington Hospital, Wellington.
Simon
S
Bann
House Surgeon, Department of General Surgery, Wellington Hospital, Wellington.
Katherine
K
Tse
D000368:Aged; D015897:Comorbidity; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009520:New Zealand; D009873:Operating Rooms / Q000458:organization & administration*; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000458:organization & administration*