• Jessele Vinluan, Claudia Retegan, Andrew Chen, and Charles Barry Beiles.
• Victorian Audit of Surgical Mortality (VASM), Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
• BMJ Open. 2014 Jun 30; 4 (6): e005554.

ObjectiveClinical management issues are contributory factors to mortality. The aim of this study was to use data from the Victorian Audit of Surgical Mortality (VASM), an educational peer-review process for surgeons, to discover differences in the incidence of these issues between surgical specialties in order to focus attention to areas of care that might be improved.DesignThis study used retrospectively analysed observational data from VASM. Clinical management issues between eight specialties were assessed using χ(2) analysis.Data SourcesVASM data were reported by participating public and private health services, the Coroner and self-reporting surgeons across Victoria.ResultsA total of 2946 specific clinical issues as deficiencies of care were reported. 15% of cases had significant issues of care. The most common clinical management issue was the delay in delivery of treatment. Other clinical issues included the quality of communication and documentation, preoperative and postoperative care, adverse events and protocol issues. There were significant differences in issues between specialties.ConclusionsThe clinical management issues presented across surgical specialties were similar; however, five issues of clinical care differed significantly in frequency across surgical specialties. The three main issues varying among specialties were complications after operation, communication and postoperative care. Addressing these clinical management issues via the peer-review process may impact positively on patient care.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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