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Ann Surg. 2009 Dec;250(6):1029-34.

Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients.

Author information

  • 1Department of Surgery, Michigan Surgical Collaborative for Outcomes Research and Evaluation (M-SCORE), University of Michigan, Ann Arbor, MI 48104, USA. aghaferi@umich.edu

Abstract

OBJECTIVE:

We sought to determine whether hospital variations in surgical mortality were due to differences in complication rates or failure to rescue rates (ie, case-fatality rates in patients with a complication).

BACKGROUND:

Wide variations in mortality after major surgery are becoming increasingly apparent. The clinical mechanisms underling these variations are largely unexplored.

METHODS:

We studied all Medicare beneficiaries undergoing 6 major operations in 2005 to 2006: pancreatectomy, esophagectomy, abdominal aortic aneurysm repair, coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement. We ranked hospitals according to risk-adjusted mortality and divided them into 5 equal groups. We then compared the incidence of complications and rates of failure to rescue between the top 20% of hospitals ("best") and bottom 20% of hospitals ("worst"). Analyses were conducted for all operations combined and for each individual procedure.

RESULTS:

For all 6 operations combined, the worst hospitals had mortality rates 2.5-fold higher than the best hospitals (8.0% vs. 3.0%). However, complication rates were similar at worst and best hospitals (36.4% vs. 32.7%). In contrast, failure to rescue rates were much higher at the worst compared with the best hospitals (16.7% vs. 6.8%). These findings persisted in analyses with individual operations and specific complications.

CONCLUSIONS:

Reducing variations in mortality will require strategies to improve the ability of high-mortality hospitals to manage postoperative complications.

PMID:
19953723
[PubMed - indexed for MEDLINE]
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