Hansen Dylan, Hansen Emma, Retegan Claudia, Morphet Julia, Beiles Charles Barry
Victorian Audit of Surgical Mortality (VASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia.
ANZ J Surg. 2019 Jan;89(1-2):16-19. doi: 10.1111/ans.14910. Epub 2018 Nov 29.
The Victorian Audit of Surgical Mortality (VASM) seeks to peer review all deaths associated with surgical care in Victoria, Australia. The effectiveness of the VASM as an educational and quality improvement tool is dependent on the accuracy of source data it receives. We aimed to examine the accuracy and quality of source data provided by the treating surgeon for peer review, and the inter-rater concordance level between the external validator findings and the treating surgeon.
Of the 629 cases that completed the VASM audit second-line peer review process over a 4-year period (from 1 July 2012 to 30 June 2016), a total of 32 (5%) were randomly selected for the external validation process. The blinded external validator was impartial to the VASM audit, and was provided only de-identified patient medical records. The analysis for the checked and validated data points and their concordance was determined using Gwet's agreement coefficient, which provides a stable inter-rater reliability coefficient not affected by prevalence and marginal probability.
The inter-rater concordance analysis suggested that there is a high level of agreement (82.9% overall) between the treating surgeon and external validator. The use of thromboembolism deterrent stockings was the only variable where agreement was poor (52.4%) with a Gwet score of 0.10 (-0.40 to 0.60).
The inter-rater concordance analysis results support the validity of the VASM process, which is dependent on the accuracy of data submitted by the treating surgeon.
维多利亚州外科手术死亡率审计（VASM）旨在对澳大利亚维多利亚州所有与外科治疗相关的死亡病例进行同行评审。VASM作为一种教育和质量改进工具的有效性取决于其收到的源数据的准确性。我们旨在检查主刀医生提供的用于同行评审的源数据的准确性和质量，以及外部验证者的调查结果与主刀医生之间的评分者间一致性水平。
在4年期间（从2012年7月1日至2016年6月30日）完成VASM审计二线同行评审过程的629例病例中，总共随机选择了32例（5%）进行外部验证过程。盲态的外部验证者对VASM审计不偏袒，仅提供去识别化的患者病历。使用Gwet一致性系数确定对检查和验证的数据点及其一致性的分析，该系数提供了一个不受患病率和边际概率影响的稳定的评分者间可靠性系数。
评分者间一致性分析表明，主刀医生与外部验证者之间存在高度一致性（总体为82.9%）。使用血栓栓塞预防袜是唯一一致性较差的变量（52.4%），Gwet评分为0.10（-0.40至0.60）。
评分者间一致性分析结果支持VASM过程的有效性，该过程取决于主刀医生提交数据的准确性。
