16 / 66
14
•
Terminal care admissions comprised 10.7% (1,131/10,607) of reported cases and were excluded from the review
process. An additional 3.9% (411/10,607) of cases were wrongly attributed to a surgical unit.
•
7.9% (836/10,607) of cases were deemed lost to follow-up due to the surgeon moving interstate, abroad, retiring
or the unattainability of medical records. These cases were excluded from the analysis.
•
13.2% (1,402/10,607) of cases could not proceed in the audit process as the treating surgeon had elected not to
participate. The rate of non-participant cases has declined from 2007–2012, in which it was 18.4%, to 3.3% in the
current audit period (2014–2015). VASM envisages that the rate of non-participant cases will decline further as
participation in VASM is now a mandatory component of attaining CPD recertification.
•
6,179 deaths had been fully audited by the census date. The outcomes from the peer review process are
restricted to those deaths and are the focus of this report. The outcomes of the remaining 6.1% (648/10,607) of
cases that are still pending should be available in the next audit report.
Verification of audit numbers
6.2.
The audit process is dependent on receiving notifications of death from participating hospitals. This requires each
hospital to prepare and submit a list of deaths that have occurred while the patient was under the care of a surgeon. In
these circumstances the discharging unit would usually be recorded as surgical; however, in some instances a patient
who has received surgical care may not be under the care of a surgeon at the time of death.
In parallel with the VASM’s audit process hospitals must also submit data to the VAED, which is maintained by the
DHHS. This is robust database providing casemix information required for hospital activity based funding. The
information allocates individual patient episodes to diagnosis-related groups (DRGs). These DRGs are specialty-
specific and provide an alternative source of mortality data. The DHHS has provided the VASM with a list of deaths
that occurred in patients with surgical DRGs over the period 1 July 2012 to 30 June 2015. A comparison of the VAED
data with the VASM reported mortality data was performed to ascertain gaps in reporting of hospital mortality.
Table 2: Mortalities reported to VAED
Audit period
Total surgeries
n
VAED reported mortalities
n (%)
2007-2012
2,949,510
10,851 (0.4%)
2012-2013
634,609
1,997 (0.3%)
2013-2014
663,768
1,924 (0.3%)
2014-2015
672,957
1,966 (0.3%)
Total
4,920,844
16,738 (0.3%)
VAED: Victorian Admitted Episodes Dataset
Audit period 1 July 2007 to 30 June 2015.
Comments:
•
The VAED indicates that during the audit period 672,957 patients received surgical care in Victorian public and
private hospitals, and of these 0.3% (1,966) resulted in auditable mortalities reported to the VASM.
•
It should be noted that the VASM and the VAED data are collected for different purposes and should be
considered complementary. The VAED is a database established for funding purposes. It contains more patients
than the VASM because surgical procedures performed by non-surgeons are included in the VAED.
•
Based on VAED data there has been a decrease in surgical mortality over the last seven years, from 0.41% to
0.3%. This is highly statistically significant (
p
<0.0001). It is postulated that one of the causal factors of this
improved outcome is the establishment of the VASM.
(6)
0.4%
Mortality rate
2007-2014
0.3%
Mortality rate
2014-2015