National surgical mortality audit may be associated with reduced mortality after emergency admission

Abstract

was used to assess changes in surgical mortality. Results: Over the 8 years surgical admissions increased by 23%, while mortality fell by 18% and the mortality per admission fell by 33% (P < 0.0001). A similar decrease was seen in all regions. The mortality reduction was overwhelmingly observed in elderly patients admitted as an emergency. Conclusion: The commencement of this nation-wide mortality audit was associated with a sharp decline in perioperative mortality. In the absence of any influences from other changes in clinical governance or new quality programmes it is probable it had a causal effect. The reduced mortality was most evident in high-risk patients. This study adds to the evidence that national audits are associated with improved outcomes.

Outcomes following emergency laparotomy in Australian public hospitals

“…This is also consistent with other Australian data which demonstrated a lower mortality than English hospitals . The Australian and New Zealand Audit of Surgical Mortality may have made an important contribution to this lower mortality …”

“…15 The Australian and New Zealand Audit of Surgical Mortality may have made an important contribution to this lower mortality. 16,17 Although there was variation (0-9.3%) in the risk-adjusted interhospital mortality this was much less than in other studies. The minimal inter-hospital variation observed in PELA was reproduced in the IHPA data for WA.…”

Systemic predictors of adverse events in a national surgical mortality audit: analysis of peer‐review data from Australia and New Zealand Audit of Surgical Mortality

“…The former have been shown to result in a reduction in surgical mortality, presumably mediated by increased vigilance for potential errors. Participation in a cross‐institutional reporting system for surgical deaths may itself engender a culture of caution, reflection and best practice . Indeed, the ANZASM process could be seen as an intentional application of the Hawthorne effect, whereby an individual's behaviour is altered simply by virtue of being observed …”

Author reply

“…The Bristol inquiry report also emphasised the need for accurate national outcome data that allowed for benchmarking, as well as the suggestion that the results of procedures done by a particular surgeon be made available when the patient is considering surgery . There is Australia‐wide evidence that even simply implementing a surgical audit reduces adverse outcomes, with the suggestion that the engagement of surgeons with data collection results in changes to their practice . Consumer involvement in the audit process may also enrich its reach and validity …”

“…7,8 Although there are geographical and administrative barriers to co-ordination and standardisation of services such as pituitary surgery across Australia, there are examples of how this has been done successfully in other contexts. 6,9 Health professionals and administrators whose responsibilities cover patients undergoing pituitary surgery should work together to turn the elephant in the room into a worthy priority.…”