Link Between Mortality and Post-Surgery Complications Unclear

Is there a correlation between rates of complications after inpatient surgery and mortality?

Background: Hospital mortality associated with inpatient surgery varies widely. Hospitals, regulatory agencies and payers have focused on reducing the rates of postoperative complications to reduce rates of mortality. Early recognition and effective management of postoperative complications once they have occurred may be equally important in reducing mortality rates.

Study design: Retrospective cohort study

Setting: American College of Surgeons National Surgical Quality Improvement Program database

Synopsis: Complication and mortality rates were calculated from 84,730 patients who had undergone inpatient general and vascular surgery between 2005 and 2007. Hospitals were ranked according to their risk-adjusted overall rate of death and divided into five groups. For hospitals in each overall mortality quintile, the incidence of overall and major complications and the rate of death from major complications were assessed.

Rates of death varied widely across hospital quintiles, from 3.5 percent in very low mortality hospitals to 6.9 percent in very high mortality hospitals. Hospitals with either very high mortality or very low mortality had similar rates of overall complications (24.6 percent and 26.9 percent, respectively) and of major complications (18.2 percent and 16.2 percent, respectively). Interestingly, mortality in patients with major complications was almost twice as high in hospitals with very high overall mortality as those with very low overall mortality (21.4 percent vs. 12.5 percent, p<0.001).

Bottom line: This study indicates that complications and mortality are not correlated at the hospital level and are more related to patient factors. However, strategies that target early recognition and efficient management of complications after inpatient surgery may help reduce hospital mortality rates.

Citation: Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368-1375.

—Reviewed by Ravindhra G. Elluru, MD, PhD