Outcomes from the Northern Territory audit of surgical mortality: Aboriginal deaths

Abstract

Background: A significant 'gap' in life expectancy exists for Australian Aboriginal people. The role of surgical care in this gap has been poorly addressed. This study has compared in-hospital surgical deaths of Aboriginal and non-Aboriginal persons in order to identify patient factors plus deficiencies of care that may have contributed to the gap. Methods: This study used retrospective data collection and prospective audit of all in-hospital surgical deaths since commencement of the Northern Territory Audit of Surgical Mortality (NTASM). Outcome measures included causes of death, coexisting factors and deficiencies of care. Results: Between June 2010 and June 2013, 190 deaths were audited (96% capture), of which 72 (38%) were Aboriginal. Aboriginal persons were younger at death (53 versus 65 years, P < 0.001) and had a higher incidence of diabetes (odds ratio = 2.8, 95% confidence interval: 1.4-5.6), renal (2.3, 1.1-4.7) and liver disease (5.7, 2.6-12.9). When adjusted for age and gender, serious cofactors were significantly more common in Aboriginal persons (3.8, 1.3-7.1). Rates of infections and all-cause trauma were comparable. There were no significant differences in the rates of complications, unplanned returns to theatre or intensive care unit, delays to surgery or whether in retrospect the surgeon considered management overall could have been improved. Conclusions: A large gap of 12 years exists for age at death between Aboriginal and non-Aboriginal persons admitted as surgical patients in the Northern Territory. Aboriginal persons had significantly more co-morbidities at time of death, particularly diabetes, renal and hepatic disease. No significant discrepancies of surgical care were identified between Aboriginal and non-Aboriginal persons.