title: The Western Australian Audit of Surgical Mortality: outcomes from the first 10 years.
abstract: The Western Australian Audit of Surgical Mortality (WAASM) is an external, peer-reviewed audit of all deaths that occur in hospital of patients under the care of a surgeon. We conducted a retrospective analysis of prospective audit data collected from 1 January 2002 to 31 December 2011. The annual number of deaths peaked in 2006, then fell 22% by 2011. After correcting for population growth, the overall reduction from 2002 to 2011 was 30% (regression analysis, P = 0.002). Some changes in practice, such as with pancreatic surgery, can be directly attributed to WAASM. There is strong evidence to suggest that WAASM improved other aspects of care, such as thromboembolic prophylaxis, consultant supervision and fluid management. A shift of high-risk patients to teaching hospitals, where there is a greater ability to "rescue" patients after complications, may have been an important factor in improved outcomes. This external, peer-reviewed mortality audit has changed surgical practice and reduced deaths. The same process should be applied to other sentinel events, and the lessons learned can also be extended to non-surgical specialties.
authors.affiliation: The Western Australian Audit of Surgical Mortality, Royal Australasian College of Surgeons (WA), Perth, WA, Australia. rjaitken@me.com.
authors.forename: Diana G
authors.initials: DG
authors.lastname: Azzam
authors.forename: C Adeline
authors.initials: CA
authors.lastname: Neo
authors.forename: Franca E
authors.initials: FE
authors.lastname: Itotoh
authors.forename: R James
authors.initials: RJ
authors.lastname: Aitken
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002423:Cause of Death / Q000639:trends*; D003430:Cross-Sectional Studies; D005440:Fluid Therapy / Q000639:trends; D019983:Guideline Adherence; D006306:Health Surveys; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008485:Medical Audit / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000401:mortality / Q000517:prevention & control; D012086:Reoperation; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000639:trends; D020246:Venous Thrombosis / Q000401:mortality / Q000517:prevention & control; D014904:Western Australia
chemical_list: D000925:Anticoagulants