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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 |
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 |
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 |
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 |
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.