title: The Western Australian Audit of Surgical Mortality: advancing surgical accountability.
abstract: OBJECTIVE
  To describe the peer review process of the Western Australian Audit of Surgical Mortality (WAASM), selected outcomes and recommendations.
  
  
  METHODS
  Prospective audit using peer review of all cases of patients who died while under the care of a Western Australian surgeon between 1 January 2002 and 30 June 2004. Audit reviews were current to 30 September 2004.
  
  
  METHODS
  194 of 202 surgeons participated after a patient died under their care.
  
  
  METHODS
  Surgeon participation, deficiencies of care, deep vein thrombosis (DVT) prophylaxis, futile surgery, postmortem reviews, proportion of operations performed by consultant surgeons.
  
  
  RESULTS
  The audit process was complete for 896 of 1647 reported deaths (54%), while a further 503 (31%) were still under review at 30 September 2004. Twenty deaths associated with terminal care were excluded from analysis. Median patient age was 80 years, and 799 of the 876 patients who died (91%) had significant comorbidities that increased the risk of death. Deficiencies of care were reported in 179/876 (20%). In 45/876 deaths (5%) the deficiency of care was assessed to have caused the death, and 15 deaths were considered preventable. The risk of a deficiency of care was 1.9 times higher in elective admissions than emergency admissions. Autopsy was undertaken in 83/768 (11%) deaths with complete data. Changes in practice were noted in some areas targeted by WAASM, such as improved DVT prophylaxis. A problem with fluid management was recorded.
  
  
  CONCLUSIONS
  Most patients who died were elderly, had complex comorbidities and were treated appropriately. The WAASM has helped to change surgical practice and emphasises the importance of ongoing systematic audit. The participation of surgeons demonstrates their commitment to accountability and supports the intention of the Royal Australasian College of Surgeons to extend the process throughout Australia and New Zealand.
authors.affiliation: School of Population Health, M431, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. james@sph.uwa.edu.au
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
authors.forename: R James
authors.initials: RJ
authors.lastname: Aitken
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
authors.forename: S Aqif
authors.initials: SA
authors.lastname: Mukhtar
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Haynes
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Mountain
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004194:Disease; D017558:Elective Surgical Procedures / Q000401:mortality; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005440:Fluid Therapy; D006801:Humans; D008485:Medical Audit; D019300:Medical Errors; D018447:Medical Futility; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018024:Peer Review, Health Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012307:Risk Factors; D012941:Social Responsibility; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000592:standards; D020246:Venous Thrombosis / Q000517:prevention & control; D014904:Western Australia / Q000453:epidemiology