AVOIDABLE DEATHS STILL OCCUR AFTER LARGE-BOWEL SURGERY

Background Postoperative death following large bowel surgery is relati vely infrequent and no large study has analysed the cause of all death s comprehensively and critically. Methods In-hospital deaths following large bowel surgery in South-East Scotland were reviewed by independe nt assessors. The audit was confidential but not anonymous. Independen t assessors' reports were returned to consultants. Results The audit d ocumented 187 deaths. The independent assessors noted an adverse event in 78 patients (42 per cent), Twenty-six deaths (14 per cent) occurre d following an anastomotic leak. A further 43 deaths (23 per cent) occ urred because surgery was delayed (17) or there was undue delay in mak ing the initial diagnosis (12) or recognizing a developing complicatio n (14), Consultants operated on only half the patients classed as Amer ican Society of Anesthesiologists grade IV or V, or undergoing a secon d or subsequent operation. Conclusion Half the patients dying in this study had identifiable deficiencies in their management. There is a cl ear need for greater consultant input with critically ill patients.