RNSH SERT Institute HAC Report

2024

RNSH SERT INSTITUTE HOSPITAL-ACQUIRED COMPLICATIONS REPORT JANUARY - DECEMBER 2024

Data Analysis and Surgical Outcomes (DASO) Unit PREPARED BY :

SURGICAL EDUCATION, RESEARCH & TRAINING (SERT) INSTITUTE ROYAL NORTH SHORE HOSPITAL

Northern Sydney Local Health District Royal North Shore Hospital Reserve Road St Leonards NSW 2065

This work is copyrighted. It may be reproduced in whole or in part for internal reporting and presentation purposes subject to the inclusion of an acknowledgement of the source. Reproduction for purposes other than those indicated above requires written permission from the SERT Institute at Royal North Shore Hospital.

Produced March 2025 Enquiries or feedback: Please email the SERT Institute directly via nslhd-rnsh-sertinstitute@health.nsw.gov.au

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Table of Contents Introduction .................................................................................................................................................................... 3

Hospital-acquired complications: Definition and selection ............................................................................................ 4

Summary of admissions with hospital-acquired complications ..................................................................................... 5

Hospital-acquired complication counts: DoSA ............................................................................................................... 6

Hospital-acquired complication counts: by DoSA specialty ............................................................................................ 7

HAC Summaries for all specialties under DoSA .............................................................................................................. 9

Breast Surgery ......................................................................................................................................................... 9

Burns, Plastics & Reconstructive Surgery ............................................................................................................. 11

Cardiothoracic Surgery ......................................................................................................................................... 14

Colorectal Surgery ................................................................................................................................................. 17

Endocrine Surgery ................................................................................................................................................. 20

Otolaryngology Head & Neck (ENT) Surgery ........................................................................................................ 23

Hand Surgery & Peripheral Nerve Surgery ........................................................................................................... 26

Neurosurgery ........................................................................................................................................................ 29

Ophthalmology ..................................................................................................................................................... 32

Orthopaedic Surgery ............................................................................................................................................. 35

Upper Gastrointestinal Surgery ............................................................................................................................ 38

Urology ................................................................................................................................................................. 41

Vascular Surgery ................................................................................................................................................... 44

Appendix ....................................................................................................................................................................... 47

Appendix A: Data sources ..................................................................................................................................... 47

Appendix B: Raw data preparation and cleaning .................................................................................................. 48

Appendix C: ACSQHC HACs 1 – 14 ........................................................................................................................ 49

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Introduction This report provides an overview of hospital-acquired complications (HACs) for patients discharged in 2024. It is intended for internal use by the DoSA Surgical Outcomes Committee only. Prior to the development of this bespoke report, several HAC reports were available to the Surgical Outcomes Committee which had varying levels of specificity and utility. This report is currently under active development and is designed to overcome the limitations of existing reports and introduce more transparency to the reporting process of HACs. The report aims to be straightforward and easy to interpret with several inclusions which differentiates it from the other reports: • Incorporating more surgically relevant complications in addition to the hospital-wide HACs selected for reporting by the Australian Commission on Safety and Quality in Healthcare (ACSQHC) • Identifying and including operative patients where their care was transferred to and were discharged by a non-surgical specialty Throughout the report development phase, senior surgeons will be consulted to improve the relevance and potential utility of the report. The findings of this report and the final iteration is expected to inform each specialty on the incidence of HACs over time and guide quality improvement initiatives to reduce HACs.

Multiple data sources were used in the development of this report:

• Admitted Patient Discovery Dashboard (source data from EDWARD) o Source of additional diagnoses and complications • Quality Improvement Data System (QIDS) Dashboard o

Source of the ACSQHC reportable HACs, taking into consideration additional criteria required for certain HACs to be flagged as per the ACSQHC

• Discern Analytics - Casemix Report (SN024) o Source of operative details

For more details on these data sources, refer to Appendix A.

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Hospital-acquired complications: Definition and selection HACs are complications for which clinical risk mitigation strategies may reduce the risk of occurrence. 1 The ACSQHC developed a national list of 16 high-priority complications, which formed the basis for a set of KPIs and improvement measures developed by NSW Health. These measures aim to broadly measure performance and enhance patient care across all healthcare facilities.

Below are the inclusion and exclusion criteria for this report:

Inclusions:

• Patients discharged by a Division of Surgery & Anaesthesia (DoSA) surgical consultant • Patients who were operated by a DoSA surgical consultant (includes admitted patients transferred to another medical specialty prior to discharge) • ASQHC HACs: 1 – 14 (see Appendix B) • Additional surgically relevant diagnoses/complications o Identified based on the diagnoses/complications associated with patients operated on in 2023

Exclusions:

• ASQHC HAC: 15 - Third- and fourth-degree perineal laceration during delivery • ASQHC HAC: 16 - Neonatal birth trauma

Interpretation considerations for this report:

• HACs do not have a time stamp, hence, unless the complication is specific to surgery, it is difficult to determine whether the complication occurred pre- or post-operatively. • For the visuals throughout this report, HACs 1-14 are classified under the parent diagnosis rather than specific diagnosis codes. Additional diagnoses, however, have been classified under specific diagnosis codes. • The reporting period is associated with the discharge date during this period as coding of the admission occurs after the patient is discharged. • Non-operative admissions are those with a DoSA discharge specialty where no operations were found to have occurred during that admission.

1 Definition of HACs per the Australian Commission on Safety and Quality in Health Care (ACSQHS) Australian Commission on Safety and Quality in Health Care, “Hospital-acquired complications (HACs)”, Australian Commission on Safety and Quality in Health Care, https://www.safetyandquality.gov.au/our-work/indicators-measurement-and- reporting/hospital-acquired-complications-hacs

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Summary of admissions with hospital-acquired complications Figure 1 below demonstrates all admissions that were discharged in the 2024 reporting period:

1. There were 10425 operative admissions: o

8.9% (n = 1023) were associated with HACs o The average duration of surgery was 160 minutes for the HAC cohort versus 70 minutes for those with no HACs o The median length of stay was 14 days for the HAC cohort versus 1 day for those with no HACs 2. There were 3217 non-operative admissions: o 3.1% (n = 102) were associated with HACs o The median length of stay was 10 days for the HAC cohort versus 2 days for those with no HACs 3. The total number of admissions with HACs was 1125 (8.2%)

With HAC (3.1%)

Figure 1. Summary of admissions with HACs in 2024

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Hospital-acquired complication counts: DoSA A total of 2246 HACs were observed for all surgical specialties under DoSA. Figure 2 groups HACs into non-operative admissions, elective operative admissions and emergency operative admissions.

0

500

1000

1500

2000

2500

DoSA

246

1462

538

Non-operative Operative (Emergency)

Operative (Elective)

Figure 2. HAC counts for DoSA in 2024

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Hospital-acquired complication counts: by DoSA specialty Figure 3 groups HACs by surgical specialty. To ensure greater accuracy, HACs were assigned specialties based on a predefined list of DoSA surgeons and their respective specialties, rather than the specialties listed in the Admitted Patient and Surginet extracts. Table 1 is a numerical summary of the chart in Figure 3.

Neurosurgery reported the highest number of HACs over this reporting period.

0

100

200

300

400

500

5

Breast Surgery

1

1

Burns/Plastics

6

112

25

Cardiothoracic Surgery

36

283

118

Colorectal Surgery

37

91

53

Endocrine Surgery

2

33

8

ENT Surgery

5

19

40

Hand Surgery & Peripheral Nerve…

2

27

12

Neurosurgery

36

302

26

Ophthalmology

8

7

Orthopaedic Surgery

24

272

70

Upper GI Surgery

74

135

101

Urology

16

20

54

Vascular Surgery

7

155

23

Non-operative Operative (Emergency)

Operative (Elective)

Figure 3. All HACs by non-operative admission, elective operative admission, and emergency operative admission, grouped by surgical specialty.

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Non-operative

Operative (Emergency)

Operative (Elective)

Total

Breast Surgery

1

5

1

7

Burns/Plastics

6

112

25

143

Cardiothoracic Surgery

36

283

118

437

Colorectal Surgery

37

91

53

181

Endocrine Surgery

2

33

8

43

ENT Surgery

5

19

40

64

Hand Surgery & Peripheral Nerve Surgery

2

27

12

41

Neurosurgery

36

302

26

364

Ophthalmology

0

8

7

15

Orthopaedic Surgery

24

272

70

366

Upper GI Surgery

74

135

101

310

Urology

16

20

54

90

Vascular Surgery

7

155

23

185

246

1462

538

2246

Table 1. Tabled summary of all HACs by non-operative admission, elective operative admission, and emergency operative admission, grouped by surgical specialty.

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HAC Summaries for all specialties under DoSA This section contains the following summaries for each surgical specialty under the current reporting period: 1. Admissions with HACs as a percentage of all admissions under the specialty, where the numerator is the number of admissions with HACs and the denominator is the number of total admissions (operative and non-operative). 2. A summary of the top 20 most frequent HACs under each specialty was obtained by combining the HACs associated with both operative and non-operative admissions.

Breast Surgery Breast Surgery had 316 admissions during this reporting period, where the patient was either discharged or operated on by a Breast surgeon. HACs were observed in 2% of all Breast surgery admissions (Figure 4).

2%

Breast Surgery

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 4. Admissions with HACs as a percentage of all admissions under Breast Surgery.

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Figure 5 and Table 2 demonstrates that the most frequent HAC was K56.7 Ileus unspecified (n = 2).

20 Most Frequent HACs Breast Surgery

20

18

16

14

12

10

8

6

4

2

2

1

1

1

1

1

0

K56.7 Ileus unspecified

3.1 Urinary tract infection

3.9 Other high impact infections

6.2 Aspiration pneumonia

7.2 Deep vein thrombosis

D64.9 Anaemia unspecified

Figure 5. Summary of the 20 most frequent HACs under Breast Surgery

Percentage of admissions

Diagnosis

n 2 1 1 1 1 1

K56.7 Ileus unspecified 3.1 Urinary tract infection

0.6% 0.3% 0.3% 0.3% 0.3% 0.3%

3.9 Other high impact infections 6.2 Aspiration pneumonia 7.2 Deep vein thrombosis D64.9 Anaemia unspecified

Table 2. Tabled summary of the 20 most frequent HACs under Breast Surgery, including the percentage of admissions associated with each HAC.

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Burns, Plastics & Reconstructive Surgery Burns, Plastics & Reconstructive Surgery had 1085 admissions during this reporting period, where the patient was either discharged or operated on by a Burns, Plastics & Reconstructive surgeon. HACs were observed in 13% of all Burns, Plastics & Reconstructive surgery admissions (Figure 6).

Burns/Plastics

13%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 6. Admissions with HACs as a percentage of all admissions under Burns, Plastics & Reconstructive Surgery.

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Figure 7 and Table 3 demonstrates that the most frequent HAC was T85.83 Haemorrhage due to internal prosthetic devices, implants and grafts, not elsewhere classified (n = 20), followed by E86 Volume depletion (n = 12).

20 Most Frequent HACs Burns, Plastics & Reconstructive Surgery

20

20

18

16

14

12

12

10

10

8

7 7

6

6

5 5 5 5 5 5 5

4 4

4

3 3 3 3 3

2

0

Figure 7. Summary of the 20 most frequent HACs under Burns, Plastics & Reconstructive Surgery.

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Percentage of admissions

Diagnosis

n

T85.83 Haemorrhage foll oth dev impl or graft

20 12 10

1.8% 1.1% 0.9% 0.6% 0.6% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.4% 0.4% 0.3% 0.3% 0.3% 0.3% 0.3%

E86 Volume depletion

11.1 Delirium

3.1 Urinary tract infection

7 7 6 5 5 5 5 5 5 5 4 4 3 3 3 3 3

3.7 Infection associated with prosthetics/ implantable devices

3.3 Pneumonia

13.2 Hypoglycaemia

3.2 Surgical site infection

3.9 Other high impact infections 6.2 Aspiration pneumonia D64.9 Anaemia unspecified

E87.6 Hypokalaemia

R09.0 Asphyxia

7.2 Deep vein thrombosis R33 Retention of urine

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

3.6 Multi-resistant organism

K91.49 Malfunction stoma digestive sys NEC T84.83 Pain foll int ortho prosth dev impl gft Y60.0 Unintent cut perf haem during surg op

Table 3. Tabled summary of the 20 most frequent HACs under Burns, Plastics & Reconstructive Surgery, including the percentage of admissions associated with each HAC.

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Cardiothoracic Surgery Cardiothoracic Surgery had 1097 admissions during this reporting period, where the patient was either discharged or operated on by a Cardiothoracic surgeon. HACs were observed in 40% of all Cardiothoracic surgery admissions (Figure 8).

Cardiothoracic Surgery

40%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 8. Admissions with HACs as a percentage of all admissions under Cardiothoracic Surgery.

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Figure 9 and Table 4 demonstrates that the most frequent HAC was 14.2 Arrhythmias (n = 58), followed by 3.3 Pneumonia (n = 47).

20 Most Frequent HACs Cardiothoracic Surgery

58

60

50

47

40

33

30

30

23

22 22

21

20

15

13 13

12

10 10

9 9 9

10

7

6 6

0

Figure 9. Summary of the 20 most frequent HACs under Cardiothoracic Surgery .

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Percentage of admissions

Diagnosis

n

14.2 Arrhythmias

58 47 33 30 23 22 22

5.3% 4.3% 3.0% 2.7% 2.1% 2.0% 2.0% 1.9% 1.4% 1.2% 1.2% 1.1% 0.9% 0.9% 0.8% 0.8% 0.8% 0.6% 0.5% 0.5%

3.3 Pneumonia

J95.84 Postprocedural pneumothorax

11.1 Delirium

I47.2 Ventricular tachycardia D64.9 Anaemia unspecified

E86 Volume depletion

6.1 Respiratory failure including acute respiratory distress syndromes requiring ventilation 21

E87.6 Hypokalaemia

15 13 13 12 10 10

6.2 Aspiration pneumonia

R09.0 Asphyxia

Y60.0 Unintent cut perf haem during surg op

14.3 Cardiac arrest

3.1 Urinary tract infection

D62 Acute posthaemorrhagic anaemia

9 9 9 7 6 6

Y44.2 Anticoagulants adverse effects Rx use Z53.3 Procedure abandoned after initiation

3.2 Surgical site infection

14.1 Heart failure and pulmonary oedema

R33 Retention of urine

Table 4. Tabled summary of the 20 most frequent HACs under Cardiothoracic Surgery, including the percentage of admissions associated with each HAC.

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Colorectal Surgery Colorectal Surgery had 1059 admissions during this reporting period, where the patient was either discharged or operated on by a Colorectal surgeon. HACs were observed in 17% of all Colorectal surgery admissions (Figure 10).

Colorectal Surgery

17%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 10. Admissions with HACs as a percentage of all admissions under Colorectal Surgery.

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Figure 11 and Table 5 that the most frequent HACs were K56.7 Ileus unspecified and Y60.0 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care (n = 13).

20 Most Frequent HACs Colorectal Surgey

20

18

16

14

13 13

12

12

11

10

9 9 9 9

8

6 6

6

5 5 5

4 4 4 4 4

4

3 3

2

0

Figure 11. Summary of the 20 most frequent HACs under Colorectal Surgery

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Percentage of admissions

Diagnosis

n

K56.7 Ileus unspecified

13 13 12 11

1.2% 1.2% 1.1% 1.0% 0.8% 0.8% 0.8% 0.8% 0.6% 0.6% 0.5% 0.5% 0.5% 0.4% 0.4% 0.4% 0.4% 0.4%

Y60.0 Unintent cut perf haem during surg op K91.63 Accid punct lacr intestine dur proc

E86 Volume depletion

11.1 Delirium

9 9 9 9 6 6 5 5 5 4 4

3.3 Pneumonia

6.2 Aspiration pneumonia

E87.6 Hypokalaemia 13.2 Hypoglycaemia

3.2 Surgical site infection 3.1 Urinary tract infection

3.9 Other high impact infections

K91.83 Leak fr anastomosis of digestive tract

14.2 Arrhythmias

3.4 Blood stream infection

6.1 Respiratory failure including acute respiratory distress syndromes requiring ventilation 4

9.1 Gastrointestinal bleeding D64.9 Anaemia unspecified

4 4

Table 5. Tabled summary of the 20 most frequent HACs under Colorectal Surgery, including the percentage of admissions associated with each HAC.

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Endocrine Surgery Endocrine Surgery had 656 admissions during this reporting period, where the patient was either discharged or operated on by an Endocrine surgeon. HACs were observed in 7% of all Endocrine surgery admissions (Figure 12).

Endocrine Surgery

7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 12. Admissions with HACs as a percentage of all admissions under Endocrine Surgery.

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Figure 13 and Table 6 demonstrates that the most frequent HAC was 11.1 Delirium (n = 6), followed by E86 Volume Depletion, E87.6 Hypokalaemia and R09.0 Asphyxia (n = 4).

20 Most Frequent HACs Endocrine Surgery

20

18

16

14

12

10

8

6

6

4 4 4

4

3 3

2 2 2 2

2

1111111111

0

Figure 13. Summary of the 20 most frequent HACs under Endocrine Surgery

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Percentage of admissions

Diagnosis

n 6 4 4 4 3 3 2 2 2 2 1 1 1 1 1 1

11.1 Delirium

0.7% 0.5% 0.5% 0.5% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1%

E86 Volume depletion E87.6 Hypokalaemia

R09.0 Asphyxia

K56.7 Ileus unspecified

Y60.0 Unintent cut perf haem during surg op

14.4 Acute coronary syndrome including unstable angina, STEMI and NSTEMI

D64.9 Anaemia unspecified

K91.63 Accid punct lacr intestine dur proc Z53.3 Procedure abandoned after initiation

13.1 Malnutrition 14.2 Arrhythmias

14.5 Infective endocarditis

2.3 Other fractures

3.2 Surgical site infection

3.3 Pneumonia

6.1 Respiratory failure including acute respiratory distress syndromes requiring ventilation 1

7.1 Pulmonary embolism

1 1 1

I26.9 Pulm embolism wo acute cor pulmonale

J95.84 Postprocedural pneumothorax

Table 6. Tabled summary of the 20 most frequent HACs under Endocrine Surgery, including the percentage of admissions associated with each HAC.

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Otolaryngology Head & Neck (ENT) Surgery Otolaryngology Head & Neck (ENT) Surgery had 868 admissions during this reporting period, where the patient was either discharged or operated on by an ENT surgeon. HACs were observed in 7% of all ENT surgery admissions (Figure 14).

ENT Surgery

7%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 14. Admissions with HACs as a percentage of all admissions under Otolaryngology Head & Neck Surgery.

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Figure 15 and Table 7 demonstrates that the most frequent HAC was Y60.0 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care (n = 8).

20 Most Frequent HACs Ear, Nose & Throat Surgery

20

18

16

14

12

10

8

8

6

4 4 4 4

4

3 3 3

2 2 2 2 2 2

2

1 1 1 1 1 1

0

Figure 15. Summary of the 20 most frequent HACs under Otolaryngology Head & Neck Surgery.

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Percentage of admissions

Diagnosis

n 8 4 4 4 4 3 3 3 2 2 2 2 2 2 1 1 1 1 1 1

Y60.0 Unintent cut perf haem during surg op

1.2% 0.6% 0.6% 0.6% 0.6% 0.5% 0.5% 0.5% 0.3% 0.3% 0.3% 0.3% 0.3% 0.3% 0.2% 0.2% 0.2% 0.2% 0.2% 0.2%

11.1 Delirium 3.3 Pneumonia

I97.34 Accid punct lacr oth vessels during proc T85.83 Haemorrhage foll oth dev impl or graft

6.2 Aspiration pneumonia D64.9 Anaemia unspecified

Y60.8 Unintent cut haem oth surg med care

13.2 Hypoglycaemia

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

3.9 Other high impact infections

E87.6 Hypokalaemia

R09.0 Asphyxia

Z53.3 Procedure abandoned after initiation 1.3 Unspecified decubitus and pressure area

14.2 Arrhythmias

14.4 Acute coronary syndrome including unstable angina, STEMI and NSTEMI

2.3 Other fractures

3.1 Urinary tract infection 7.2 Deep vein thrombosis

Table 7. Tabled summary of the 20 most frequent HACs under Otolaryngology Head & Neck Surgery, including the percentage of admissions associated with each HAC.

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Hand Surgery & Peripheral Nerve Surgery Hand & Peripheral Nerve Surgery had 1767 admissions during this reporting period, where the patient was either discharged or operated on by a Hand surgeon. HACs were observed in 2% of all Hand surgery admissions (Figure 16).

2%

Hand Surgery & Peripheral Nerve Surgery

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 16. Admissions with HACs as a percentage of all admissions under Hand Surgery & Peripheral Nerve Surgery.

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Figure 17 and Table 8 demonstrates that the most frequent HAC was Y60.0 Unintentional cut, puncture, perforation or haemorrhage during surgical care (n = 5).

20 Most Frequent HACs Hand Surgery & Peripheral Nerve Surgery

20

18

16

14

12

10

8

6

5

4

3 3

2 2 2 2 2 2 2

2

1111111111

0

Figure 17. Summary of the 20 most frequent HACs under Hand Surgery & Peripheral Nerve Surgery

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Percentage of admissions

Diagnosis

n 5 3 3 2 2 2

Y60.0 Unintent cut perf haem during surg op

0.3% 0.2% 0.2% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1%

3.3 Pneumonia

Y60.8 Unintent cut haem oth surg med care

14.2 Arrhythmias

3.1 Urinary tract infection

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

6.1 Respiratory failure including acute respiratory distress syndromes requiring ventilation 2

6.2 Aspiration pneumonia

2 2 2 1 1 1 1 1 1 1 1 1 1

E86 Volume depletion

L89.15 Pressure injury stage II ischium

13.2 Hypoglycaemia

3.2 Surgical site infection

3.9 Other high impact infections

7.1 Pulmonary embolism 7.2 Deep vein thrombosis

I26.9 Pulm embolism wo acute cor pulmonale

I47.2 Ventricular tachycardia

I80.42 Phleb & thrombophleb deep upp extrem I97.34 Accid punct lacr oth vessels during proc I97.9 Intra/postop disrd circulatory sys unsp

Table 8. Tabled summary of the 20 most frequent HACs under Hand Surgery & Peripheral Nerve Surgery, including the percentage of admissions associated with each HAC.

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Neurosurgery Neurosurgery had 1583 admissions during this reporting period, where the patient was either discharged or operated on by a Neurosurgeon. HACs were observed in 23% of all Neurosurgery admissions (Figure 18).

Neurosurgery

23%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 18. Admissions with HACs as a percentage of all admissions under Neurosurgery.

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Figure 19 and Table 9 demonstrates that the most frequent HAC was 6.2 Aspiration pneumonia (n = 45), followed by 3.1 Urinary Tract Infection (n = 42).

20 Most Frequent HACs Neurosurgery

60

50

45

42

40

30

22

21

20

20

14

13

12

10 10 10

9 9

8 8

10

7 7

6 6

5

0

Figure 19. Summary of the 20 most frequent HACs under Neurosurgery

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OFFICIAL: Sensitive – NSW Government

Percentage of admissions

Diagnosis

n

6.2 Aspiration pneumonia 3.1 Urinary tract infection

45 42 22 21 20 14 13 12 10 10 10

2.8% 2.7% 1.4% 1.3% 1.3% 0.9% 0.8% 0.8% 0.6% 0.6% 0.6% 0.6% 0.6% 0.5% 0.5% 0.4% 0.4% 0.4% 0.4% 0.3%

11.1 Delirium

E87.6 Hypokalaemia

3.3 Pneumonia

14.2 Arrhythmias

R33 Retention of urine

Y60.0 Unintent cut perf haem during surg op

7.2 Deep vein thrombosis D64.9 Anaemia unspecified

E86 Volume depletion

3.9 Other high impact infections

9 9 8 8 7 7 6 6 5

G45.9 Transient cerebral ischaemic attack unsp

6.1 Respiratory failure including acute respiratory distress syndromes requiring ventilation

G97.31 Accid punct lacr dura during proc T84.83 Pain foll int ortho prosth dev impl gft Z53.3 Procedure abandoned after initiation

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

R09.0 Asphyxia

13.2 Hypoglycaemia

Table 9. Tabled summary of the 20 most frequent HACs under Neurosurgery, including the percentage of admissions associated with each HAC.

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OFFICIAL: Sensitive – NSW Government

Ophthalmology Ophthalmology had 1202 admissions during this reporting period, where the patient was either discharged or operated on by an Ophthalmologist. HACs were observed in 1% of all Ophthalmology admissions (Figure 20).

1%

Ophthalmology

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 20. Admissions with HACs as a percentage of all admissions under Ophthalmology.

32

OFFICIAL: Sensitive – NSW Government

Figure 21 and Table 10 demonstrates that the most frequent HAC was Y60.0 Unintentional cut, puncture, perforation or haemorrhage during surgical care (n = 4), followed by 3.9 Other high impact infections (n = 2).

20 Most Frequent HACs Ophthalmology

20

18

16

14

12

10

8

6

4

4

2

2

1

1

1

1

1

1

1

1

1

0

Figure 21. Summary of the 20 most frequent HACs under Ophthalmology

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OFFICIAL: Sensitive – NSW Government

Percentage of admissions

Diagnosis

n 4 2 1 1 1 1 1 1 1 1 1

Y60.0 Unintent cut perf haem during surg op

0.3% 0.2% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1% 0.1%

3.9 Other high impact infections

11.1 Delirium

13.2 Hypoglycaemia

3.1 Urinary tract infection

3.3 Pneumonia

E86 Volume depletion

I47.2 Ventricular tachycardia

K56.7 Ileus unspecified

T81.5 FB left in body cv or op wound foll proc Y60.8 Unintent cut haem oth surg med care

Table 10. Tabled summary of the 20 most frequent HACs under Ophthalmology, including the percentage of admissions associated with each HAC.

34

OFFICIAL: Sensitive – NSW Government

Orthopaedic Surgery Orthopaedic Surgery had 1669 admissions during this reporting period, where the patient was either discharged or operated on by an Orthopaedic surgeon. HACs were observed in 22% of all Orthopaedic admissions (Figure 22).

Orthopaedic Surgery

22%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 22. Admissions with HACs as a percentage of all admissions under Orthopaedic Surgery.

35

OFFICIAL: Sensitive – NSW Government

Figure 23 and Table 11 demonstrates that the most frequent HAC was D64.9 Anaemia unspecified (n = 31), followed by E86 Volume depletion and T84.83 Haemorrhage due to internal orthopaedic prosthetic devices, implants and grafts (n = 28).

20 Most Frequent HACs Orthopaedic Surgery

60

50

40

31

28 28

30

25

20

16 16

14 14 14

13

12

11

10 10

9

10

7

6

5 5 5

0

Figure 23. Summary of the 20 most frequent HACs under Orthopaedic Surgery

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OFFICIAL: Sensitive – NSW Government

Percentage of admissions

Diagnosis

n

D64.9 Anaemia unspecified

31 28 28 25 16 16 14 14 14 13 12 11 10 10

1.9% 1.7% 1.7% 1.5% 1.0% 1.0% 0.8% 0.8% 0.8% 0.8% 0.7% 0.7% 0.6% 0.6% 0.5%

E86 Volume depletion

T84.83 Pain foll int ortho prosth dev impl gft

11.1 Delirium 3.3 Pneumonia

Y60.0 Unintent cut perf haem during surg op

6.2 Aspiration pneumonia

R09.0 Asphyxia

R33 Retention of urine 3.1 Urinary tract infection 7.2 Deep vein thrombosis

G97.31 Accid punct lacr dura during proc

3.9 Other high impact infections

D62 Acute posthaemorrhagic anaemia

3.2 Surgical site infection

9

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

7

0.4%

3.7 Infection associated with prosthetics/ implantable devices

6 5 5 5

0.4% 0.3% 0.3% 0.3%

13.2 Hypoglycaemia

14.2 Arrhythmias

E87.6 Hypokalaemia

Table 11. Tabled summary of the 20 most frequent HACs under Orthopaedic Surgery, including the percentage of admissions associated with each HAC.

37

OFFICIAL: Sensitive – NSW Government

Upper Gastrointestinal Surgery Upper GI Surgery had 1598 admissions during this reporting period, where the patient was either discharged or operated on by an Upper GI surgeon. HACs were observed in 19% of all Upper GI admissions (Figure 24).

Upper GI Surgery

19%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 24. Admissions with HACs as a percentage of all admissions under Upper GI Surgery.

38

OFFICIAL: Sensitive – NSW Government

Figure 25 and Table 12 demonstrates that the most frequent HAC was K56.7 Ileus unspecified (n = 25), followed by 11.1 Delirium and 13.2 Hypoglycaemia (n = 18).

20 Most Frequent HACs Upper GI Surgery

60

50

40

30

25

18 18

20

17

16

14

11 11

10 10 10

9

8

10

7 7

6 6 6 6

5

0

Figure 25. Summary of the 20 most frequent HACs under Upper GI Surgery

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OFFICIAL: Sensitive – NSW Government

Percentage of admissions

Diagnosis

n

K56.7 Ileus unspecified

25 18 18 17 16 14 11 11 10 10 10

1.6% 1.1% 1.1% 1.1% 1.0% 0.9% 0.7% 0.7% 0.6% 0.6% 0.6% 0.6% 0.5% 0.4% 0.4% 0.4% 0.4% 0.4% 0.4% 0.3%

11.1 Delirium

13.2 Hypoglycaemia

Y60.0 Unintent cut perf haem during surg op

3.3 Pneumonia

E87.6 Hypokalaemia

3.9 Other high impact infections

T85.5 Mech comp GI prosth dev impl gft

3.2 Surgical site infection 6.2 Aspiration pneumonia D64.9 Anaemia unspecified

R09.0 Asphyxia

9 8 7 7 6 6 6 6 5

E86 Volume depletion

3.7 Infection associated with prosthetics/ implantable devices

K91.63 Accid punct lacr intestine dur proc

7.1 Pulmonary embolism

I26.9 Pulm embolism wo acute cor pulmonale K91.64 Accid punct lacr gallbladder dur proc Z53.3 Procedure abandoned after initiation

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

Table 12. Tabled summary of the 20 most frequent HACs under Upper GI Surgery, including the percentage of admissions associated with each HAC.

40

OFFICIAL: Sensitive – NSW Government

Urology Urology had 1183 admissions during this reporting period, where the patient was either discharged or operated on by a Urologist. HACs were observed in 8% of all Urology admissions (Figure 26).

Urology

8%

0%

10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 26. Admissions with HACs as a percentage of all admissions under Urology.

41

OFFICIAL: Sensitive – NSW Government

Figure 27 and Table 13 demonstrates that the most frequent HAC was D64.9 Anaemia unspecified and Y60.0 Unintentional cut, puncture, perforation or haemorrhage during surgical and medical care (n = 9).

20 Most Frequent HACs Urology

20

18

16

14

12

10

9 9

8

6 6 6

6

5

4 4

4

3 3 3 3

2 2 2 2 2

2

1 1 1

0

Figure 27. Summary of the 20 most frequent HACs under Urology

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OFFICIAL: Sensitive – NSW Government

Percentage of admissions

Diagnosis

n 9 9 6 6 6 5 4 4 3 3 3

D64.9 Anaemia unspecified

0.8% 0.8% 0.5% 0.5% 0.5% 0.4% 0.3% 0.3% 0.3% 0.3% 0.3%

Y60.0 Unintent cut perf haem during surg op

3.1 Urinary tract infection E86 Volume depletion K56.7 Ileus unspecified

Y60.8 Unintent cut haem oth surg med care

3.3 Pneumonia

R33 Retention of urine

11.1 Delirium

3.2 Surgical site infection

3.9 Other high impact infections

6.1 Respiratory failure including acute respiratory distress syndromes requiring ventilation

3

0.3%

13.2 Hypoglycaemia

2 2 2 2 2 1 1 1

0.2% 0.2% 0.2% 0.2% 0.2% 0.1% 0.1% 0.1%

14.4 Acute coronary syndrome including unstable angina, STEMI and NSTEMI

D62 Acute post haemorrhagic anaemia J95.84 Postprocedural pneumothorax T83.5 Infectn inf dt prosth dev impl urin sys

10.2 Haemorrhagic disorder due to circulating anticoagulants

14.3 Cardiac arrest

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

Table 13. Tabled summary of the 20 most frequent HACs under Urology, including the percentage of admissions associated with each HAC.

43

OFFICIAL: Sensitive – NSW Government

Vascular Surgery Vascular Surgery had 803 admissions during this reporting period, where the patient was either discharged or operated on by a Vascular surgeon. HACs were observed in 23% of all Vascular surgery admissions (Figure 28).

Vascular Surgery

23%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

With HAC Without HAC

Figure 28. Admissions with HACs as a percentage of all admissions under Vascular Surgery.

44

OFFICIAL: Sensitive – NSW Government

Figure 29 and Table 14 demonstrates that the most frequent HAC was D64.9 Anaemia unspecified (n = 16), followed by 6.2 Pneumonia and E86 Volume depletion (n = 14s).

20 Most Frequent HACs Vascular Surgery

20

18

16

16

14 14

14

12

10

9

8 8

8

7 7 7

6 6 6

6

5

4 4 4 4 4

4

3 3

2

0

Figure 29. Summary of the 20 most frequent HACs under Vascular Surgery

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OFFICIAL: Sensitive – NSW Government

Percentage of admissions

Diagnosis

n

D64.9 Anaemia unspecified

16 14 14

2.0% 1.7% 1.7% 1.1% 1.0% 1.0% 0.9% 0.9% 0.9% 0.7% 0.7% 0.7% 0.6% 0.5% 0.5% 0.5% 0.5% 0.5%

3.3 Pneumonia

E86 Volume depletion R33 Retention of urine

9 8 8 7 7 7 6 6 6 5 4 4 4 4 4

11.1 Delirium

13.2 Hypoglycaemia

14.2 Arrhythmias

I97.34 Accid punct lacr oth vessels during proc Z53.3 Procedure abandoned after initiation

6.2 Aspiration pneumonia

E87.6 Hypokalaemia

Y60.0 Unintent cut perf haem during surg op

D62 Acute posthaemorrhagic anaemia

14.4 Acute coronary syndrome including unstable angina, STEMI and NSTEMI

3.2 Surgical site infection

3.9 Other high impact infections 9.1 Gastrointestinal bleeding

K56.7 Ileus unspecified

3.5 Infections or inflammatory complications associated with peripheral/central venous catheters

3

0.4%

7.1 Pulmonary embolism

3

0.4%

Table 14. Tabled summary of the 20 most frequent HACs under Vascular Surgery, including the percentage of admissions associated with each HAC.

46

OFFICIAL: Sensitive – NSW Government

Appendix Appendix A: Data sources 1. Admitted Patient Discovery Dashboard (source data from EDWARD): Accessed via the NSLHD Data Hub. This dashboard is prepared by the NSLHD Analytics & Performance Unit (APU). Report filters: • Service End Date = Period of interest • Health Organisation = Royal North Shore Hospital • Condition Onset Flag = 1 (see next section for details on this filter) 2. Quality Improvement Data System (QIDS) Dashboard – Report 38 Health Information Exchange (HIE) HAC 1-14 by Location Accessed via the Clinical Excellence Commission (CEC) portal. QIDS dashboards are available to all NSW health service providers for the purpose of improving safety and quality of healthcare. Report 38 summarises HACs 1-14 by location, based on criteria set by the Australian Commission on Safety and Quality in Healthcare (ACSQHC). See next section for further details. Report selections/filters: • Location = Northern Sydney LHD – Royal North Shore Hospital • Service (SRG) = All • Discharge Date = Period of interest • HAC Version = 3.1 • Count By = Count Numerator by HAC Complication • Report By = Count 3. Casemix Report (SN024) An extract of surgical cases and relevant details obtained using Discern Analytics (eMR). To ensure that all operations under all admissions are captured when comparing this dataset with the HAC extracts, an ongoing data file dating back two calendar years is updated monthly and used to perform the required analyses. Report filters: • Facility = Royal North Shore Hospital • Surgical Area = All • Date range dependent on ongoing extract

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OFFICIAL: Sensitive – NSW Government

Appendix B: Raw data preparation and cleaning HACs under surgical and non-operative admissions are extracted using the logic outlined in Figure 2.

Admitted Patient Dataset (Filtered for additional diagnoses)

QIDs Dataset Contains all HACs 1 – 14

HAC Master

Filter rows by matching with Casemix extract, and filtering at the consultant level to include only relevant departments.

Filter rows by taking out all surgical admissions and selecting rows where the last

Individual Service Provider is under a DoSA specialty.

HAC Operative admission

HAC Non-operative admission

Figure 2. Flow chart of the extraction process for HACs under operative and non-operative admissions.

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OFFICIAL: Sensitive – NSW Government

Appendix C: ACSQHC HACs 1 – 14 Complication

Diagnosis

Pressure injury

1.

• • • • •

Stage III ulcer Stage IV ulcer

Unspecified decubitus ulcer and pressure area

Unstageable pressure injury Suspected deep tissue injury

Falls resulting in fracture or intracranial injury

2.

• • •

Intracranial injury

Fractured neck of femur

Other fractures

Healthcare-associated infection

• • • •

3.

Urinary tract infection Surgical site infection

Pneumonia

Blood stream infection

• Infections or inflammatory complications associated with peripheral/central venous catheters • Multi-resistant organism • Infection associated with prosthetics/implantable devices • Gastrointestinal infections • Other high impact infections • Post-operative haemorrhage/haematoma requiring transfusion and/or return to theatre • Surgical wound dehiscence • Anastomotic leak • Vascular graft failure • Other surgical complications requiring unplanned return to theatre

4. Surgical complications requiring unplanned return to theatre

Unplanned intensive care unit admission

5.

Unplanned admission to intensive care unit

Respiratory complications

6.

• Respiratory failure including acute respiratory distress syndrome requiring ventilation • Aspiration pneumonia • Pulmonary oedema

Venous thromboembolism

7.

• •

Pulmonary embolism Deep vein thrombosis

Renal failure

8.

• Renal failure requiring haemodialysis or continuous veno- venous haemodialysis

Gastrointestinal bleeding

9.

Gastrointestinal bleeding

10. Medication complications

• Drug related respiratory complications/depression • Haemorrhagic disorder due to circulating anticoagulants • Movement disorders due to psychotropic medication • Serious alteration to conscious state due to psychotropic medication

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OFFICIAL: Sensitive – NSW Government

Complication

Diagnosis

11. Delirium

Delirium

12. Incontinence

• •

Urinary incontinence Faecal incontinence

13. Endocrine complications

• •

Malnutrition

Hypoglycaemia

14. Cardiac complications

• • •

Heart failure and pulmonary oedema

Arrhythmias Cardiac arrest

• Acute coronary syndrome including unstable angina, STEMI and NSTEMI • Infective endocarditis

50

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