Mapping changes in surgical mortality over 9 years by peer review audit.

The paper describes changes in surgical and anesthetic practice identified by the Scottish Audit of Surgical Mortality (SASM) during the first nine years of continuous, peer review audit. Adverse events were more frequently due to failures of hospital systems or process than to individual clinician errors. Fewer adverse events were identified as having contributed to or caused the death of patients over time. Failure to use deep vein thrombosis prophylaxis and failure to use high-dependency or intensive therapy units became less common, once highlighted by the SASM.