title: Australian and New Zealand Audit of Surgical Mortality: concordance between reported and audited clinical events and delays in management in surgical mortality patients.
abstract: BACKGROUND
  The Australian and New Zealand Audit of Surgical Mortality (ANZASM) is a nationwide confidential peer review of deaths associated with surgical care. This study assesses the concordance between treating surgeons and peer reviewers in reporting clinical events and delays in management.
  
  
  METHODS
  This is a retrospective cross-sectional analysis of deaths in 2009 and 2010. Cases that went through the process of submission of details by the surgeon in a structured surgical case form (SCF), first-line assessment (FLA) and a more detailed second-line assessment (SLA) were included. Significant clinical events reported for these patients were categorized and analysed for concordance.
  
  
  RESULTS
  Of the 11,303 notifications of death to the ANZASM, 6507 (57.6%) were audited and 685 (10.5%) required the entire review process. Nationally, the most significant events were post-operative complications, poor preoperative assessment and delay to surgery or diagnosis. The SCF submissions reported 338 events, as compared with 1009 and 985 events reported through FLA and SLA, respectively (P = 0.01). Treating surgeons and assessors attributed 29-30% of events to factors outside the surgeon's control. Surgeons felt that delay to surgery or diagnosis was a significant event in 6.6% of cases, in contrast to 20% by assessors (P = 0.01). Preoperative management could be improved in 19% of cases according to surgeons, compared with 45 and 36% according to the assessors (P < 0.001).
  
  
  CONCLUSIONS
  There is significant discordance between treating surgeons and assessors. This suggests the need for in-depth analysis and possible refinement of the audit process.
authors.affiliation: Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Ravish S
authors.initials: RS
authors.lastname: Raju
authors.forename: Gordon S
authors.initials: GS
authors.lastname: Guy
authors.forename: John B F
authors.initials: JB
authors.lastname: Field
authors.forename: George K
authors.initials: GK
authors.lastname: Kiroff
authors.forename: Wendy
authors.initials: W
authors.lastname: Babidge
authors.forename: Guy J
authors.initials: GJ
authors.lastname: Maddern
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality*; D008297:Male; D008485:Medical Audit / Q000379:methods; D008875:Middle Aged; D009520:New Zealand; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*
keywords: audit; delay; mortality; significant events; surgery