National surgical mortality audit may be associated with reduced mortality after emergency admission
National surgical mortality audit may be associated with reduced mortality after emergency admission
复制标题
DOI：
10.1111/ans.14170
复制
发表时间：
2017-10-01
影响因子：
1.7
通讯作者：
Aitken, R. James
中科院分区：
文献类型：
--
作者：
Kiermeier, Andreas;Babidge, Wendy J.;Aitken, R. James
背景：西澳大利亚州手术死亡率审计于2002年成立。一项为期10年的分析表明，这是随后外科医生相关死亡率下降的主要驱动因素。2004年至2010年期间，皇家澳大利亚外科学院在其他州建立了死亡率审计。本研究的目的是检查澳大利亚卫生与福利研究所（AIHW）的国家数据，以确定是否有类似的死亡率下降，观察整个Australia.Method：AIHW收集所有手术入院的程序和结果数据。结果：8年间，外科住院率上升了23%，死亡率下降了18%，每次住院死亡率下降了33%（P < 0.0001）。所有区域都出现了类似的下降。死亡率的降低是压倒性的，在老年患者入院作为emergency.Conclusion：这个全国范围内的死亡率审计的开始与围手术期死亡率急剧下降。在临床管理或新质量计划的其他变化没有任何影响的情况下，它很可能具有因果关系。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，国家审计与改善成果有关。
Background: 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.Method: 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.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.