Abstract
Background
Over the past decade, improvements in perioperative care have been widely introduced throughout the United States, yet there is no clear indication that the death rate following surgery has improved. We sought to evaluate the number of deaths after surgery in the United States over a 10-year period and to evaluate trends in postoperative mortality.
Methods
Using the National Hospital Discharge Survey, we identified patients who underwent a surgical procedure and subsequently died in the hospital within 30 days of admission.
Results
In 1996 there were 12,250,000 hospitalizations involving surgery, rising to 13,668,000 in 2006. Postoperative deaths, however, declined during this same period, from 201,000 to 156,000 (P < 0.01), giving a postoperative in-hospital death ratio (death per hospitalization) of 1.64 and 1.14% (P < 0.001), respectively, for the two time frames.
Conclusions
The death rate following surgery is substantial but appears to have improved. Such mortality statistics provide an essential measure of the public health impact of surgical care. Incorporating mortality statistics following therapeutic intervention is an essential strategy for regional and national surveillance of care delivery.
Similar content being viewed by others
References
Heron M, Hoyert D, Murphy S et al (2009) Deaths: final data for 2006. National Vital Statistics Reports, vol 57 no 14, Hyattsville, MD, National Center for Health Statistics, Cited 24 July 2009; available from: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_14.pdf
Anderson GF, Frogner BK (2008) Health spending in OECD countries: obtaining value per dollar. Health Aff (Millwood) 27:1718–1727
World Health Organization-World Alliance for Patient Safety (2008) WHO Guidelines for Safe Surgery, 1st Edition, Geneva, WHO
Joint Commission (2008) Surgical Care Improvement Project Core Measure Set. Cited 24 July 2009, available from: http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/SCIP+Core+Measure+Set.htm
Joint Commission (2009) Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. Cited 24 July 2009, available from: http://www.jointcommission.org/PatientSafety/UniversalProtocol/
Rosenthal MB (2007) Nonpayment for performance? Medicare’s new reimbursement rule. N Engl J Med 357:1573–1575
Milstein A (2009) Ending extra payment for “never events”—stronger incentives for patients’ safety. N Engl J Med 360:2388–2390
Hall BL, Hamilton BH, Richards K et al (2009) Does surgical quality improve in the American College of Surgeons National Surgical Quality Improvement Program: an evaluation of all participating hospitals. Ann Surg 250:363–376
Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. N Engl J Med 361:1368–1375
Learn PA, Bach PB (2010) A decade of mortality reductions in major oncologic surgery: the impact of centralization and quality improvement. Med Care 48:1041–1049
Weiser TG, Makary MA, Haynes AB et al (2009) Standardised metrics for global surgical surveillance. Lancet 374:1113–1117
Dennison C, Pokras R (2000) Design and operation of the National Hospital Discharge Survey: 1988 redesign. Vital and Health Statistics, Series 1(39):1–42
Debas H, Gosselin R, McCord C et al. (2006) Surgery. In: Disease Control Priorities in Developing Countries (2nd Edn), The international bank for reconstruction and development/The World Bank, Washington
Agency for Healthcare Research and Quality: Healthcare Cost and Utilization Project (2007) Clinical Classifications Software (CCS) for ICD-9-CM Fact Sheet, Rockville, MD: AHRQ. Cited 24 July 2009, available from: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccsfactsheet.jsp
US Bureau of the Census (2001) Current Population Survey: Annual Demographic Survey (Table HINC-07). Cited 23 October 2009, available from: http://pubdb3.census.gov/macro/032001/hhinc/new07_000.htm
US Bureau of the Census (2000) United States Census 2000. Cited 24 July 2009, available from http://www.census.gov/main/www/cen2000.html
Ghali WA, Ash AS, Hall RE et al (1997) Statewide quality improvement initiatives and mortality after cardiac surgery. JAMA 277:379–382
Hannan EL, Kilburn H Jr, Racz M et al (1994) Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 271:761–766
Matchar DB, Westermann-Clark EV, McCrory DC et al (2005) Dissemination of evidence-based practice center reports. Ann Intern Med 142(12 Pt 2):1120–1125
Meyer GS, Battles J, Hart JC et al (2004) The US Agency for Healthcare Research and Quality’s activities in patient safety research. Int J Qual Health Care 15(Suppl 1):i25–i30
Classen DC, Evans RS, Pestotnik SL et al (1992) The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 326:281–286
Van den Berghe G, Wouters P, Weekers F et al (2001) Intensive insulin therapy in the critically ill patients. N Engl J Med 345:1359–1367
Geerts WH, Pineo GF, Heit JA et al (2004) Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 126(3 Suppl):338S–400S
Poldermans D, Boersma E, Bax JJ et al (1999) The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch echocardiographic cardiac risk evaluation applying stress echocardiography study group. N Engl J Med 341:1789–1794
Ferguson TB Jr, Coombs LP, Peterson ED (2002) Preoperative beta-blocker use and mortality and morbidity following CABG surgery in North America. JAMA 287:2221–2227
Khuri SF, Henderson WG, Daley J et al (2008) Successful implementation of the Department of Veterans affairs national surgical quality improvement program in the private sector: the patient safety in surgery study. Ann Surg 248:329–336
Acknowledgments
The authors are grateful to Angela Bader from the Harvard School of Public Health and Sandra Decker and Jennifer Madans from the National Center for Health Statistics for their help and insightful feedback during preparation of this manuscript. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Weiser, T.G., Semel, M.E., Simon, A.E. et al. In-hospital Death following Inpatient Surgical Procedures in the United States, 1996–2006. World J Surg 35, 1950–1956 (2011). https://doi.org/10.1007/s00268-011-1169-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-011-1169-5