HMN 2025: How ‘Inadequate’ skills are linked to surgery-related deaths

At least half of the deaths of people undergoing major types of surgery in Australia were caused by non-technical errors, sparking calls for nationwide improvements.

Using data from 2012–2019, researchers from the University of Adelaide and the Basil Hetzel Institute investigated the deaths of Australian patients who underwent general, cardiothoracic, orthopedic, vascular, and neuro surgeries. The researchers chose to focus on these specialties because they have the highest number of surgical care-related deaths.

“At least 50% of surgical care-related deaths in these areas were linked to non-technical errors including decision making, situational awareness, communication and teamwork,” said Professor Guy Maddern, the senior author of the study and Professor of Surgery at the University of Adelaide.

“Inadequate non-technical skills can have fatal consequences and helping surgeons to improve in this area should be a priority for Australia’s health care system.”

The researchers examined 3,422 cases for the study and found that the risk and type of non-technical errors differed depending on the type of surgery.

“General surgery had the highest number of non-technical errors, followed by vascular surgery, cardiothoracic surgery, neurosurgery and orthopedic surgery,” said Professor Maddern. “For general and orthopedic surgery, situational awareness errors were more common than decision-making errors. It was a different story for vascular, cardiothoracic and neuro surgeries, where decision-making errors were more frequently linked to patient deaths.

“Concerningly, there were no major improvements in these errors over time, other than a small decline in cases linked to general surgery, but the total number of deaths in this category is still high.”

Differences in patient and admission characteristics were also reviewed but not found to be statistically significant for any of the surgery specialties.

The research did not include New South Wales, as the Australian and New Zealand Audit of Surgical Mortality dataset used for this study does not have access to that information.

The study has been published in the Medical Journal of Australia, with the results prompting calls for action.

“Errors in judgment, surgery-related decision making and inadequate patient assessment all contribute to patient harm. The persistently high number of related deaths indicates that systemwide improvement is crucial and should be prioritized over specialty-specific interventions,” said Professor Maddern.

“To prevent avoidable patient deaths, surgical training organizations must adopt evidence-based initiatives that provide surgeons with the opportunity to improve their skills, particularly in decision making and situational awareness.

“Coaching, which is often employed in high performance professions, may be one way to deliver this; however, further research is required to identify the most effective method.”

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