title: Analysis of the causes and effects of delay before diagnosis using surgical mortality data.
abstract: BACKGROUND
  The aim of the study was to assess the causes and effects of delay in diagnosis in surgical patients who died in 20 public hospitals participating in the Queensland Audit of Surgical Mortality (QASM) in Australia.
  
  
  METHODS
  This was a retrospective cross-sectional analysis (June 2007 to December 2011) of deaths reported to QASM. Deaths were assigned to one of two groups (no delay or delay in diagnosis). Logistic regression was used to compare the association of delay with surgical complications, both overall and by surgical specialty.
  
  
  RESULTS
  A total of 3139 deaths were reported. Diagnostic delay was reported in 293 (9·3 per cent). The primary cause of delay was attributed to diagnostic support services (41·7 per cent). Some 174 (13·8 per cent) of 1259 general (gastrointestinal) surgery patients experienced delayed diagnosis. Delay across all surgical specialties was associated with an increased risk of unplanned return to theatre (odds ratio (OR) 1·77, 95 per cent confidence interval 1·24 to 2·52), of being treated in intensive care (OR 1·71, 1·15 to 2·54) and of postoperative complications (OR 1·39, 1·05 to 1·85).
  
  
  CONCLUSIONS
  General (gastrointestinal) surgery patients who experienced delayed diagnosis were at increased risk of postoperative complications.
authors.affiliation: Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, Brisbane, Queensland, Australia.
authors.forename: J B
authors.initials: JB
authors.lastname: North
authors.forename: F J
authors.initials: FJ
authors.lastname: Blackford
authors.forename: D
authors.initials: D
authors.lastname: Wall
authors.forename: J
authors.initials: J
authors.lastname: Allen
authors.forename: S
authors.initials: S
authors.lastname: Faint
authors.forename: R S
authors.initials: RS
authors.lastname: Ware
authors.forename: T
authors.initials: T
authors.lastname: Rey-Conde
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011793:Queensland / Q000453:epidemiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality / Q000706:statistics & numerical data*; D061665:Time-to-Treatment / Q000706:statistics & numerical data