U.S. Survey Shows Decline in Postsurgical Deaths

By Victoria Stern
The number of inpatient deaths within 30 days of surgery in the United States has declined by just over 15% between 1996 and 2006, according to a nationwide report published in Surgery (2012;151:171-182). Before this analysis, national rates and patterns of death after surgery were unknown.

Investigators from the Harvard School of Public Health and the Center for Surgery and Public Health at Brigham and Women’s Hospital, in Boston, compared deaths that occurred within 30 days of admission for patients undergoing surgery in 1996 and 2006. Using the Nationwide Inpatient Sample, which covers approximately 20% of hospitals in the United States, the researchers examined the inpatient 30-day death rate for all surgical procedures, procedures with the most deaths, and high-risk cardiovascular and cancer procedures, and for patients who suffered a recorded complication.

The researchers found that hospital admissions with surgical procedures increased by 14.4% (from just over 12.5 million in 1996 to more than 14.3 million in 2006), while deaths within 30 days of admission dropped by 15.4% (from 224,111 in 1996 to 189,690 in 2006). The adjusted 30-day inpatient mortality rate decreased from 1.68% to 1.32% during that period (P<0.001).

“The decline in the number of deaths may have occurred through reduced mortality of individual procedures, reductions in the volume of high-risk procedures and the rescue of patients who had a complication,” the authors wrote.

The investigators identified 21 procedures associated with the most deaths in 1996 (accounting for 3,160,643 admissions and 101,146 deaths) and found that, in 2006, the same procedures accounted for 26.5% fewer deaths (3,339,722 admissions and 74,254 deaths). Additionally, the inpatient 30-day mortality rate for patients who had a complication decreased from 12.10% to 9.84% (P<0.001).

Mortality decreased for nine of 14 high-risk cardiovascular and cancer procedures. The incidence of sepsis and pneumonia increased from 1996 to 2006, but the failure-to-rescue rate declined during the study period for both groups (sepsis, from 18.69% to 14.03%; pneumonia, from 8.54% to 7.34%).

Overall, the investigators estimated that 51,000 fewer people died in 2006 than would have if the postsurgical mortality rate from 1996 had continued. The authors noted that “additional research to determine the underlying causes for decreased mortality is warranted.”

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