Risks: Better Odds for Surviving Complex Surgery

The odds that a Medicare patient will die after undergoing one of eight high-risk operations have fallen sharply, an analysis of medical records has found. Fewer hospitals are performing these procedures, and the hospitals that do them are high-volume facilities that tend to have more experience caring for high-risk patients, the researchers found. But that trend does not fully account for the decline in deaths.

Patients who had surgery to repair abdominal aortic aneurysms experienced the steepest decline in mortality in the analysis. Their death rate fell to 2.8 percent in 2007-8 from 4.4 percent in 1999-2000 — a 36 percent drop, due mostly to new medical technology, the researchers said.

Death rates also fell among patients after operations to treat cancers of the esophagus, pancreas, lung and bladder, and among those who had had coronary artery bypass grafting, aortic valve replacement and carotid endarterectomy, according to the study, published this month in The New England Journal of Medicine.

The declines in mortality translate into about 2,000 fewer deaths each year, said Dr. John D. Birkmeyer, director of the Center for Healthcare Outcomes and Policy at University of Michigan and the paper’s senior author. Much of the improvement stems from a new emphasis on patient safety, Dr. Birkmeyer added.

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