Kiermeier Andreas, Babidge Wendy J, McCulloch Glenn A J, Maddern Guy J, Watters David A, Aitken R James
Statistical Process Improvement Consulting and Training Pty Ltd., Adelaide, South Australia, Australia.
Audit and Academic Surgery Division, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.
ANZ J Surg. 2017 Oct;87(10):830-836. doi: 10.1111/ans.14170. Epub 2017 Aug 20.
The Western Australian Audit of Surgical Mortality was established in 2002. A 10-year analysis suggested it was the primary driver in the subsequent fall in surgeon-related mortality. Between 2004 and 2010 the Royal Australasian College of Surgeons established mortality audits in other states. The aim of this study was to examine national data from the Australian Institute of Health and Welfare (AIHW) to determine if a similar fall in mortality was observed across Australia.
The AIHW collects procedure and outcome data for all surgical admissions. AIHW data from 2005/2006 to 2012/2013 was used to assess changes in surgical mortality.
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.
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.
西澳大利亚外科手术死亡率审计于2002年启动。一项为期10年的分析表明，它是随后外科医生相关死亡率下降的主要推动因素。2004年至2010年期间，皇家澳大利亚外科学院在其他州开展了死亡率审计。本研究的目的是审查澳大利亚卫生与福利研究所（AIHW）的全国数据，以确定澳大利亚各地是否观察到类似的死亡率下降情况。
AIHW收集所有外科手术入院病例的手术过程和结果数据。使用2005/2006年至2012/2013年的AIHW数据评估手术死亡率的变化。
在这8年中，外科手术入院病例增加了23%，而死亡率下降了18%，每次入院的死亡率下降了33%（P<0.0001）。所有地区都出现了类似的下降。死亡率的降低在以急诊入院的老年患者中最为明显。
这项全国性死亡率审计的启动与围手术期死亡率的急剧下降有关。在没有临床管理方面的其他变化或新的质量计划的任何影响的情况下，它很可能具有因果效应。死亡率的降低在高危患者中最为明显。这项研究进一步证明了全国性审计与改善结果相关。
