A review carried out by the Scottish Audit of Surgical Mortality (SASM), have found that the number of patients who died while in surgical care in Scotland has risen.
Mistakes and failures, such as lack of intensive care facilities and delays in carrying out operations, were judged to have contributed to 189 deaths.
Key issues identified in this year's report include failing to transfer the patient to a high-dependency or intensive care unit.
The auditors raised this as a problem in 43 cases in 2003 – more than double the number where it was an issue in 2002.
Delays in obtaining X-rays and scans were also recorded in the reports on 70 patients who died, and in 17 cases the hold-up was thought to have contributed to their fate.
The assessors also criticised the seniority of the surgeon present in theatre in 19 cases, although this was fewer than the year before.
For the first time, SASM recorded the number of patients who had contracted an infection in hospital, such as the superbug MRSA, before their death.
SASM chairman Professor Graham Teasdale said surgical care in Scotland remained a "very safe process".
