Assessing Perioperative Outcomes in Victoria

Assessing Perioperative Outcomes in Victoria


CIA: Dr Alexander Clarke

Project summary

A review of Hospital Safety and Quality in Victoria, the “Targeting zero” report by Dr Stephen Duckett et al concluded that complications are commonplace within our healthcare system and that approximately 50% are avoidable. Duckett stated that the Victorian Health Department “makes far too little use of the routine data at its disposal to monitor patient outcomes and investigate red flags suggesting poor care”.
The Assessing Perioperative Outcomes in Victoria (APOV) project will use the Victorian Admitted Episodes Dataset to characterise perioperative care and outcomes in Victoria and aims to identify factors associated with quality and safety. Anaesthetic, surgical, and patient factors that shall be analysed including the use of regional anaesthesia, surgical technique and centre volumes, and demographics such as Regional and Aboriginal and Torres Strait Islander status. We shall compare these outcomes to international benchmarks, and, if identified, highlight “red flags suggestive of poor care” with a view to improving clinical practice.

1. To characterise and benchmark important perioperative outcomes in Victoria.
2. To evaluate if anaesthetic techniques, including neuraxial and/or peripheral nerve blocks, are associated with improved outcomes following surgery and other situations where they are routinely employed (i.e. labour, hip and rib fractures)
3. To evaluate if other demographic, patient or procedural factors may be associated with improved or adverse perioperative outcomes for a range of procedures and their associated pathologies
4. To inform the feasibility of the prospective perioperative trials in Victoria.
5. To develop a greater understanding of clinical coding practices in Victoria and potentially inform how these may be altered in order to improve the utility of large health databases

Ethics approval has already been obtained from St Vincent’s Hospital Melbourne (St Vincent’s HREC no: LRR 139/21). VAED data comprising all surgical, obstetric and rib fracture patients in Victorian Hospitals from 2006 onwards will be obtained. Patients of all ages will be included. Surgical patients will be identified through the coding of an anaesthetic Australian Classification of Health Interventions (ACHI) procedure code. Patients who may or not require an anaesthetic intervention, such as labour and rib fracture(s) will be identified using their respective International Classification of Diseases (ICD-10-AM) diagnosis codes. Other pathologies for which surgical intervention may or may not be pursued, such as acute upper gastrointestinal bleeding, will be identified by their ICD-10-AM diagnosis codes. Through the Centre for Victorian Data Linkage (CVDL), the Victorian Death Index (VDI) will be used to provided anonymised mortality figures. An anonymous, unique patient identifier will be used to link specific patient outcomes where patients were readmitted at the same or different hospitals.

The APOV project will shed light on the morbidity and mortality experienced by surgical patients in Victoria. Though retrospective, it will re-examine a number of outcomes assessed by the pivotal ANZCA CTN REASON study with a number of distinct advantages. These include capturing all public and private patients, tracking how patient characteristics and complication rates have changed over a period of more than 15 years, and having the potential to efficiently re-audit Victorian surgical outcomes at regular intervals into the future. APOV’s capacity for more targeted assessments of factors influencing patient outcomes has been demonstrated by Chief Investigators Alexander Clarke and Nathaniel Hiscock. Using similar methods, they revealed an association between regional anaesthesia and improved arteriovenous fistula outcomes. Their work was awarded the 2020 ANZCA Trainee Academic Prize. The GiRAF study, funded by the ANZCA research grants program, will hopefully build upon this association through a prospective RCT.

Chief investigators

Dr Alexandre Clarke
Dr Nathaniel Hiscock
St Vincent's Hospital, Melbourne



The project was awarded A$10,000 funding through the ANZCA research grants program for 2024.   

Last updated 10:56 15.12.2023