At least half of 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, orthopaedic, vascular, and neuro surgeries. The researchers chose to focus on these specialities because they have the highest number of surgical care-related deaths.

“At least 50 per cent 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 healthcare system.”

3422 cases were examined in the study, with researchers finding the risk and type of non-technical errors differed depending on the type of surgery.

“General surgery had the highest amount of non-technical errors, followed by vascular surgery, cardiothoracic surgery, neurosurgery and orthopaedic surgery,” said Professor Maddern.

“For general and orthopaedic 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 judgement, 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 prioritised over specialty-specific interventions,” said Professor Maddern.

“To prevent avoidable patient deaths, surgical training organisations 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.”

The University of Adelaide and the University of South Australia are joining forces to become Australia’s new major university – Adelaide University. Building on the strengths, legacies and resources of two leading universities, Adelaide University will deliver globally relevant research at scale, innovative, industry-informed teaching and an outstanding student experience. Adelaide University will open its doors in January 2026. Find out more on the Adelaide University website