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Outcome Data

The upper GI unit has carefully chosen a number of outcome and quality measures that will be reported on annually and freely available. These include information on referral patterns, performance against national surgical targets, specific procedural data and research and publication outputs. 

The information in this section summarizes the upper gastrointestinal units experience with the major surgical procedures (gastro-oesophageal resections, pancreatic resections, hepatic resections and cholecystectomy) that it carries out on an annual basis. The information is taken from the Department of Surgery audit that is updated and reviewed weekly. Information is presented on anastomotic leak rates for gastro-oesophageal surgery, bile leak rates for hepatic resection and cholecystectomy, pancreatic leak rates for pancreatic resection and 30 and 90 day mortality is presented for all procedures. The leak rates are derived from audit codes specifically coding for these when they are diagnosed and also include patients in whom an intra-abdominal collection was diagnosed as a collection is often a sign of a leak. All complications are those graded Clavien-Dindo1 grade 3 or above meaning they were significant and required specific treatment.

All adverse outcomes are reviewed in the weekly Department of Surgery morbidity and mortality meeting as well as a formal quarterly in depth review by the upper gastrointestinal multidisciplinary team.

1.Dindo D; Demartines N; Clavian P. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-213

One fifth of operations were undertaken laparoscopically.

Three patients had signs of a small radiological leak at the oesophageal anastomosis on a contrast swallow undertaken on day 7 post surgery. No patients reviewed surgical intervention and all settled with conservative management.

  Procedures Leaks (CD≥III) 30 Day Mortality 90 Day Mortality
2014 27 4 1 2
2015 23 0 1 3
2016 25 2 0 1
2017 30 2 0 0
2018 28 3 0 0

Gastro-oesophogeal Surgery (2014-2018)

Commentary

  • Three quarters of 2018 cases were open procedures, and all but one of the post-op leaks and 90 day deaths were in open cases.

One third of operations were undertaken laparoscopically.

One patient died of a cerebrovascular accident on day 5 following an extended right hepatectomy.

  Procedures Leaks (CD≥III) 30 Day Mortality 90 Day Mortality
2014 38 2 0 2
2015 41 1 2 3
2016 38 2 0 0
2017 43 4 3 3
2018 30 0 1 1

Hepatic Surgery (2014-2018)Commentary

  • Overall, >95% of 2018 cases were laparoscopic procedures, and 70% of the post-op leaks and 70% of 90 day deaths were in laparoscopic cases.

One third of operations were undertaken laparoscopically

Two patients died in the community at 87 and 89 days from progression of disease (new liver and lung metastases) following pancreatic resection for adenocarcinoma.

  Procedures Leaks (CD≥III) 30 Day Mortality 90 Day Mortality
2014 20 4 1 1
2015 22 0 2 3
2016 19 0 2 2
2017 27 1 1 1
2018 19 0 0 2

Pancreatic Surgery (2014-2018)

Commentary

  • Overall, >85% of 2018 cases were open procedures, and all of the post-op leaks and 90 day deaths were in open cases.

97% of operations were undertaken laparoscopically.

Five patients developed bile leaks following laparoscopic cholecystectomy (3 acute, 2 elective). All were from the cystic duct stump and managed with endoscopic stent placement only.

  Procedures Leaks (CD≥III) 30 Day Mortality 90 Day Mortality
2014 596 8 1 3
2015 543 7 4 5
2016 567 4 1 1
2017 646 5 0 1
2018 610 5 0 0

Simple Cholecystectomy (2014-2018)Commentary

  • Overall, >95% of 2018 cases were laparoscopic procedures, and 70% of the post-op leaks and 70% of 90 day deaths were in laparoscopic cases.

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