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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
Author(s) -
Turner Richard C.,
Simpson Jr Steve,
Bhalerao Mrunmayee
Publication year - 2019
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15386
Subject(s) - medicine , audit , adverse effect , specialty , judgement , medline , emergency medicine , health care , family medicine , accounting , law , business , economic growth , political science , economics
Abstract Background Peer review of surgical deaths can identify deficits in individual and systemic delivery of healthcare, ultimately informing quality improvement. Methods 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. Results 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. Conclusion 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.