Adverse events in surgery in Scotland show a steady fall

BMJ 2003; 327 doi: (Published 11 December 2003) Cite this as: BMJ 2003;327:1367
  1. Bryan Christie
  1. Edinburgh

    Adverse events that contribute to deaths of patients while they are under surgical care have fallen steadily over the past five years in Scotland.

    Figures from the 2002 Scottish Audit for Surgical Mortality show that poor standards of care caused the deaths of 12 patients who had been expected to survive and made a substantial contribution to a further 221 deaths.

    The most common problems were delays in surgery, missed and delayed diagnoses, operations being done by inexperienced junior staff, and wrong operations being done.

    Although the audit shows that further improvements could be made in surgical care, it points to several positive trends: the number of adverse events continues to fall, the presence of senior staff at operations is rising, and postoperative care is improving.

    The number of deaths related to the failure to use a high dependency or intensive care unit—either through omission or non-availability—fell from 113 in 2000 to 21 last year.

    Mortality after emergency admission was 2.29% and after elective surgery 0.27%.

    The chairman of the audit, Professor John Temple, said: “These figures show an improvement in the quality of care delivered by doctors and nurses working with surgical patients.” He said it showed that Scotland had a “generally safe system.”

    Professor Graham Teasdale, the newly elected president of the Royal College of Physicians and Surgeons of Glasgow, blamed pressure and failings in the NHS system rather than in the care provided by individual clinicians for the problems identified by the audit.

    Participation by surgeons in the audit is voluntary, and, although 4449 deaths were recorded under surgical care in 2002, only 4004 were included in the audit. A group of 28 surgeons who had more than 10 patients die under their care failed to achieve the target return rate of 85% of cases.

    Professor Temple said that important lessons for safer and improved patient care are being lost because 10% of cases are not being submitted for review. “Clinicians and hospitals which are not part of an adequate patient safety structure should not be surprised if their patients lose faith in them and the service offered,” he added.

    The report notes that guidance from the General Medical Council states that a doctor must take part in confidential inquiries to help reduce risk to patients. It adds that persistent failure to comply with the audit could be seen as a breach of this requirement.

    The report is available at

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