Mapping changes in surgical mortality over 9 years by peer review audit.
BACKGROUND
There is increasing public scrutiny of deaths among surgical patients. This analysis sought evidence of changes in practice over time in the management of patients who died under surgical care.


METHODS
The surgeons and anaesthetists in National Health Service hospitals providing the care of all surgical patients in Scotland participated in the Scottish Audit of Surgical Mortality (SASM). Data from peer review audit, critical event analysis and individual feedback of deaths while in surgical care over 9 years (1994-2002) were examined for trends over time.


RESULTS
Over a 9-year period, 40,448 patients died while in surgical care. Consultant surgeon and anaesthetist involvement in decision making and operating increased significantly (P < 0.001), and death after elective surgery declined to 0.27 per cent of elective operations. Adverse events were more frequently due to failures of hospital systems or process than to individual clinician errors. Fewer adverse events were identified as having contributed to or caused the death of patients over time (P < 0.001). Failure to use deep vein thrombosis (DVT) prophylaxis and failure to use high-dependency or intensive therapy units (HDU/ITU) became less common, once highlighted by the SASM.


CONCLUSIONS
Through continuous peer review audit, the SASM has mapped and may have contributed to changes in surgical and anaesthetic practice over a 9-year period, indicating that the rate of adverse events can be decreased by changing clinician practice (DVT prophylaxis) and provision of facilities (HDU/ITU). Similar approaches should be considered by other medical specialties.
Department of Surgery and Molecular Oncology, University of Dundee, Dundee, UK. a.m.thompson@dundee.ac.uk
A M
AM
Thompson
Z
Z
Ashraf
H
H
Burton
P A
PA
Stonebridge
D000368:Aged; D000758:Anesthesia / Q000401:mortality*; D016009:Chi-Square Distribution; D003422:Critical Care / Q000639:trends; D004638:Emergency Treatment / Q000401:mortality; D006801:Humans; D008485:Medical Audit; D009026:Mortality / Q000639:trends; D010380:Peer Review; D011364:Professional Practice / Q000639:trends; D012044:Regression Analysis; D012606:Scotland / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000401:mortality*