Turner Richard C, Simpson Steve, Bhalerao Mrunmayee
School of Medicine, University of Tasmania, Hobart, Tasmania, Australia.
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
ANZ J Surg. 2019 Nov;89(11):1398-1403. doi: 10.1111/ans.15386. Epub 2019 Sep 3.
Peer review of surgical deaths can identify deficits in individual and systemic delivery of healthcare, ultimately informing quality improvement.
From 2008 to 2016, cases reported to the Australia and New Zealand Audit of Surgical Mortality were analysed. Variables associated with peer-judged adverse events were sought.
Of 21 045 cases evaluated, 24.8% incurred at least one adverse event judgement. The proportion of cases with reported adverse event significantly decreased over time. Following adjustment for demographic and clinical characteristics, significant negative patient-related associations were advanced age, greater American Society of Anesthesiologists grade, and neurological and malignant comorbidities. Significant associations were also found with systemic or organizational factors, including state/territory, surgical specialty and hospital regionality.
Examination of this peer-reviewed database revealed systemic or organizational predictors of adverse events that may have implications for quality improvement at an institutional or jurisdictional level. The extent to which these associations are due to the peer-review process itself should be the focus of further research.
对外科手术死亡病例进行同行评审能够识别个体及医疗系统在医疗服务提供方面的不足，最终为质量改进提供依据。
分析了2008年至2016年期间向澳大利亚和新西兰外科手术死亡率审计机构报告的病例。寻找与同行判定的不良事件相关的变量。
在评估的21045例病例中，24.8%至少发生了一次不良事件判定。报告有不良事件的病例比例随时间显著下降。在对人口统计学和临床特征进行调整后，与患者相关的显著负相关因素为高龄、美国麻醉医师协会分级较高以及神经和恶性合并症。还发现与系统或组织因素存在显著关联，包括州/领地、外科专科和医院所在地区。
对这个经过同行评审的数据库进行检查，揭示了不良事件的系统或组织预测因素，这些因素可能对机构或辖区层面的质量改进产生影响。这些关联在多大程度上归因于同行评审过程本身，应成为进一步研究的重点。
