Jacky Chen, Nathaniel Hiscock, Alexander Clarke, Simon Crouch, Tom Abbott, Brian Cowie, Tuong Phan
Australian administrative databases are widely used across broad surgical specialties for outcomes research. The validity of these studies remains contingent on coding accuracy and an understanding of the inherent data limitations. The current literature is state-focused, limiting broader generalisability of findings.
BACKGROUND: Administrative databases are increasingly used in perioperative research in Australia. However, the applications of these datasets and the associated strengths and limitations have not been comprehensively synthesised.
METHODS: A systematic review of observational studies using Australian administrative datasets to examine perioperative outcomes was conducted across MEDLINE, EMBASE, CINAHL and Web of Science on the 4 February 2026. Studies were categorised by primary methodological application. Two reviewers independently screened studies and extracted data. Risk of bias was assessed using ROBINS-I.
RESULTS: Of 3485 records identified, 167 publications met inclusion criteria. Studies spanned multiple surgical specialties and jurisdictions and clustered into seven themes: (1) outcome risk modelling (n = 50), identifying and stratifying factors associated with postoperative outcomes; (2) temporal epidemiology (n = 24), examining changes in surgical activity and outcomes over time; 14 studies spanned both outcome risk modelling and temporal epidemiology themes; (3) surgical comparison (n = 23), evaluating outcome differences between operative approaches or treatment strategies; (4) hospital benchmarking (n = 21), assessing variation across institutions, sectors and regions; (5) health economics (n = 20), analysing costs and resource utilisation; (6) policy evaluation (n = 8), investigating effects of guideline implementation or system-level reforms and (7) health equity assessment (n = 7), exploring disparities in perioperative outcomes across demographics and socioeconomic groups.
CONCLUSION: Australian administrative databases are widely used across broad surgical specialties for outcomes research. The validity of these studies remains contingent on coding accuracy and an understanding of the inherent data limitations. The current literature is state-focused, limiting broader generalisability of findings.