Postoperative Morbidity Linked to Complication Care

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There is no surgery that has a zero complication rate. The rate of complications from inpatient surgery is similar from hospital to hospital, but the mortality rates appear linked to care of those complications.

Amir Ghaferi, MD, and colleagues from the University of Michigan in Ann Arbor reported in the October 1 issue of the New England Journal of Medicine that a hospital's ability to care for postoperative complications may be a key factor in surgical mortality rates.

The researchers looked at data from 186 hospitals in the American College of Surgeons National Surgical Quality Improvement Program. They identified 84,730 patients between 2005 to 2007 who had one of 42 general and vascular inpatient surgery. Only 23% of surgical patients in the database fit their criteria, but this study cohort included 68% of deaths in the database.

The participating hospitals were divided into five groups, based on their surgical mortality rates. Hospitals in the lowest group had an average mortality rate of 3.5%, compared with 6.9% in the highest quintile.

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Complication studied including such things as infection, pneumonia, MI, stroke, renal insufficiency, and septic shock, as well as a subset of major complications.

The researchers found that hospitals with either very high mortality or very low mortality had similar rates of overall complications (24.6% and 26.9%, respectively) and of major complications (18.2% and 16.2%, respectively).

However, the mortality rate in patients with major complications was almost twice as high in hospitals with very high overall mortality as in those with very low overall mortality (21.4% vs. 12.5%, P<0.001).

The researchers concluded that it is not only important to aim at avoiding complications, but it is important to be able to properly care for complications that occur in order to reduce moralities.

“Timely recognition and effective management of complications will be important in reducing deaths after inpatient surgery," the researchers concluded.

Sources:
Ghaferi AA, et al "Variation in Hospital Mortality Associated with Inpatient Surgery" N Engl J Med 2009; 361: 1368-75.
Jacobs, DO "Variation in hospital mortality associated with inpatient surgery -- An S.O.S." N Engl J Med 2009; 361: 1398-1400.

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