{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T13:18:13Z","timestamp":1761311893688,"version":"3.40.5"},"reference-count":31,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T00:00:00Z","timestamp":1654646400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>One\u2010third of Australia's population reside in rural and remote areas. This audit aims to describe all\u2010causes of mortality in rural general surgical patients, and identify areas of improvement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective multi\u2010centre study involving four South Australian hospitals (Mt Gambier, Whyalla, Port Augusta, and Port Lincoln). All general surgical inpatients admitted from June 2014 to September 2019 were analysed to identify all\u2010cause of mortality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 80 mortalities were recorded out of 26\u2009996 admissions. The overall mortality rate of 0.3% was the same as the 2020 Victorian state\u2010wide Audit of Surgical Mortality. No mortality was secondary to trauma. Mean age was 79\u2009\u00b1\u200911\u2009years and ASA was 3.9\u00a0\u00b1\u20091. Malignancy was associated in over a third of cases (41.2%), mostly colorectal and pancreatic. Most cases were related to general surgical subspecialties: colorectal (51.3%), upper gastrointestinal (21.3%), hepatopancreaticobiliary (13.8%); however, there were also vascular (6.3%) and urology (3.8%) cases. The most common causes of mortality were large bowel obstruction (13.4%), ischemic bowel (10.4%), and small bowel obstruction (7.5%). Majority of mortality were beyond the surgeon's control (73.8%). Of the 21 potentially preventable mortalities, 42.9% were attributed to aspiration pneumonia and decompensated heart failure. Only one (1.3%) mortality case was due to pulmonary embolism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rural general surgical mortalities occur in older, comorbid patients. Rural surgeons should be equipped to manage basic subspeciality conditions. To further reduce mortalities, clear protocols to prevent aspiration pneumonia and resuscitation associated fluid overload are needed.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.17833","type":"journal-article","created":{"date-parts":[[2022,6,8]],"date-time":"2022-06-08T12:38:21Z","timestamp":1654691901000},"page":"1681-1691","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Analysis of surgical mortality in rural South Australia: a review of four major rural hospital in South Australia"],"prefix":"10.1111","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-2011","authenticated-orcid":false,"given":"Jianliang","family":"Liu","sequence":"first","affiliation":[{"name":"Discipline of Surgery The University of Adelaide, The Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying Yang","family":"Ting","sequence":"additional","affiliation":[{"name":"Discipline of Surgery The University of Adelaide, The Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0650-9153","authenticated-orcid":false,"given":"Markus","family":"Trochsler","sequence":"additional","affiliation":[{"name":"Discipline of Surgery The University of Adelaide, The Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8066-7259","authenticated-orcid":false,"given":"Jessica","family":"Reid","sequence":"additional","affiliation":[{"name":"Discipline of Surgery The University of Adelaide, The Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Anthony","sequence":"additional","affiliation":[{"name":"Discipline of Surgery The University of Adelaide, The Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2064-181X","authenticated-orcid":false,"given":"Guy","family":"Maddern","sequence":"additional","affiliation":[{"name":"Discipline of Surgery The University of Adelaide, The Queen Elizabeth Hospital  Adelaide South Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,6,8]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Australian Institute of Health and Welfare.Rural & Remote Australians. 5th ed. Canberra: Commonwealth of Australia. [Updated 23 Sept 2019; Cited 06 Oct 2020.] Available from URL:https:\/\/www.aihw.gov.au\/rural-health-rrma-classification#:~:text=The%20term%20rural%20and%20remote regional%2C%20Remote%20or%20Very%20remote."},{"key":"e_1_2_10_3_1","unstructured":"Australian Institute of Health and Welfare.Rural Regional and Remote Health: Indicators of Health Status and Determinants of Health [PDF on internet] second edition. Canberra: Commonwealth of Australia. [Updated 15 Nov 2017; Cited 06 Oct 2020.] Available from URL:https:\/\/www.aihw.gov.au\/reports\/rural-remote-australians\/rural-regional-remote-health-indicators\/contents\/table-of-contents."},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1584.2008.01029.x"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.08.010"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15083"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ans.15167"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajr.12428"},{"key":"e_1_2_10_9_1","unstructured":"Australian Institute of Health and Welfare.Episode of admitted Patient Care: admission Urgency Status. Canberra: Commonwealth of Australia. [Updated 28 Sept 2021; Cited 28 Oct 2021.] Available from URL:https:\/\/meteor.aihw.gov.au\/content\/index.phtml\/itemId\/686084."},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1071\/AH13163"},{"key":"e_1_2_10_11_1","unstructured":"South Australia Health.Mount Gambier and districts health service. Adelaide: Commonwealth of Australia. [Updated 5 Sept 2021; Cited 28 Oct 2021.] Available from URL:https:\/\/www.sahealth.sa.gov.au\/wps\/wcm\/connect\/public+content\/sa+health+internet\/services\/hospitals\/regional+hospitals+and+health+services\/lclhn+hospitals+and+health+services\/mount+gambier+and+districts+health+service\/mount+gambier+and+districts+health+service"},{"key":"e_1_2_10_12_1","unstructured":"Australian Bureau of Statistics.2016 Census QuickStats: Mount Gambier. Canberra: Commonwealth of Australia. [Updated 30 Sept 2020; Cited 28 Oct 2021.] Available from URL:https:\/\/quickstats.censusdata.abs.gov.au\/census_services\/getproduct\/census\/2016\/quickstat\/SSC40940?opendocument#:~:text=In%20the%202016%20Census%2C%20there up%202.3%25%20of%20the%20population.&text=The%20median%20age%20of%20people State%20Suburbs)%20was%2040%20years."},{"key":"e_1_2_10_13_1","unstructured":"South Australia Health.Whyalla Hospital and Health Service. Adelaide: Commonwealth of Australia. [Updated 31 Aug 2021; Cited 28 Oct 2021.] Available from URL:https:\/\/www.sahealth.sa.gov.au\/wps\/wcm\/connect\/public+content\/sa+health+internet\/services\/hospitals\/regional+hospitals+and+health+services\/funlhn+hospitals+and+health+services\/whyalla+hospital+and+health+service\/whyalla+hospital+and+health+service."},{"key":"e_1_2_10_14_1","unstructured":"Australian Bureau of Statistics.2016 Census QuickStats Whyalla. Canberra: Commonwealth of Australia. [Updated 30 Sept 2020; Cited 28 Oct 2021.] Available from URL:https:\/\/quickstats.censusdata.abs.gov.au\/census_services\/getproduct\/census\/2016\/quickstat\/UCL412003#:~:text=In%20the%202016%20Census%2C%20there up%204.8%25%20of%20the%20population."},{"key":"e_1_2_10_15_1","unstructured":"South Australia Health.Port Augusta Hospital and Regional Health Service. Adelaide: Commonwealth of Australia. [Updated 31 Aug 2021; cited 28 Oct 2021]. Available from URL:https:\/\/www.sahealth.sa.gov.au\/wps\/wcm\/connect\/public+content\/sa+health+internet\/services\/hospitals\/regional+hospitals+and+health+services\/funlhn+hospitals+and+health+services\/port+augusta+hospital+and+regional+health+service\/port+augusta+hospital+and+regional+health+service."},{"key":"e_1_2_10_16_1","unstructured":"Australian Bureau of Statistics.2016 Census QuickStats: Port Augusta. Canberra: Commonwealth of Australia. [Updated 30 Sept 2020; Cited 28 Oct 2021.] Available from URL:https:\/\/quickstats.censusdata.abs.gov.au\/census_services\/getproduct\/census\/2016\/quickstat\/SSC41175."},{"key":"e_1_2_10_17_1","unstructured":"South Australia Health.Port Lincoln Health Service Adelaide: commonwealth of Australia. [Updated 31 August 2021; Cited 28 Oct 2021.] Available from URL:https:\/\/www.sahealth.sa.gov.au\/wps\/wcm\/connect\/public+content\/sa+health+internet\/services\/hospitals\/regional+hospitals+and+health+services\/efnlhn+hospitals+and+health+services\/port+lincoln+health+service\/port+lincoln+health+service."},{"key":"e_1_2_10_18_1","unstructured":"Australian Bureau of Statistics.2016 census QuickStats \u2010 Port Lincoln. Canberra: Commonwealth of Australia. [Updated 30 Sept 2020; Cited 28 Oct 2021.] Available from URL:https:\/\/quickstats.censusdata.abs.gov.au\/census_services\/getproduct\/census\/2016\/quickstat\/SSC41187."},{"key":"e_1_2_10_19_1","unstructured":"Australian Institute of Health and Welfare.Rural & remote health Australian. Canberra: Commonwealth of Australia. [Updated 22 Oct 2020; Cited 27 Feb 2022.] Available from URL:https:\/\/www.surgeons.org\/\u2010\/media\/Project\/RACS\/surgeons\u2010org\/files\/surgical\u2010mortality\u2010audits\/vasm\/2021\u201012\u201008\u2010VASM\u2010Report2020.pdf?rev=ac58fb267a91488f94b55b90690308c2&hash=1E662069738B870E4DA1D439FA57AE4A"},{"key":"e_1_2_10_20_1","unstructured":"Royal Australasian College of Surgeons.Victorian Audit of Surgical Mortalit. Victoria: Commonwealth of Australia. [Updated 4 Nov 2019; Cited 28 Oct 2021.] Available from URL:https:\/\/www.surgeons.org\/\u2010\/media\/Project\/RACS\/surgeons\u2010org\/files\/surgical\u2010mortality\u2010audits\/vasm\/2019\u201011\u20104\u2010rpt\u2010vasm\u2010report\u2010full\u2010web\u2010final.pdf."},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2012.02808.x"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0090-4295(99)00448-3"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(05)80306-X"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1067\/mva.1990.19860"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1583\/13-4626MR.1"},{"key":"e_1_2_10_26_1","first-page":"303","article-title":"Development of an intervention model for the prevention of aspiration pneumonia in high\u2010risk patients on a medical\u2010surgical unit","volume":"21","author":"Echevarria IM","year":"2012","journal-title":"Medsurg Nurs."},{"key":"e_1_2_10_27_1","first-page":"609","article-title":"Team approach toward the prevention of aspiration pneumonia","volume":"38","author":"Hennies S","year":"2007","journal-title":"Stroke"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.4037\/ccn2011462"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2006.03.004"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-199007000-00010"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tmrv.2013.02.001"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-018-1188-6"}],"container-title":["ANZ Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.17833","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ans.17833","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ans.17833","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T13:29:02Z","timestamp":1692797342000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ans.17833"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,8]]},"references-count":31,"journal-issue":{"issue":"7-8","published-print":{"date-parts":[[2022,7]]}},"alternative-id":["10.1111\/ans.17833"],"URL":"https:\/\/doi.org\/10.1111\/ans.17833","archive":["Portico"],"relation":{},"ISSN":["1445-1433","1445-2197"],"issn-type":[{"type":"print","value":"1445-1433"},{"type":"electronic","value":"1445-2197"}],"subject":[],"published":{"date-parts":[[2022,6,8]]},"assertion":[{"value":"2021-11-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-22","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}