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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
| 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 |
Commentary
- For 2017, one patient underwent reoperation following gastrectomy for a perforation at the hepatic flexure and one patient died of rapidly progressive recurrent cancer within 90 days of surgery.
| 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 |
Commentary
- For 2017, four patients were treated with transampullary stents for bile leaks from the liver edge. Three patients died in the post-operative period, one from post-operative pancreatitis and two from small liver remnants and hepatic insufficiency.
| 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 |
Commentary
- For 2017, one patient developed a pancreatic leak following pancreaticoduodenectomy which was managed with drainage only. One co-morbid patient died of a stroke four days following a distal pancreatectomy.
| 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 |
Commentary
- For 2017, four patients with cystic duct stump leaks following acute cholecystectomy for gangrenous cholecystitis were successfully treated with temporary endoscopic stents. One patient died in the community within 90 days due to an underlying haematological condition.