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Death after Bowel Resection: Patient Disease, Not Surgeon Error

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Although bowel resection is associated with a significant mortality rate, little is known about the demographics of the patients and how often surgical error is the primary cause of death. We sought to use a rigorous prospective quality database incorporating standardized peer review, to define how often patients die from provider-related causes.

Materials and Methods

All patients undergoing bowel resection with anastomosis at a university hospital from July 2003 to June 2006 were entered into a prospectively maintained quality database. Patients were seen daily with house staff by a specially trained nurse practitioner who recorded demographics and complications. Clinical case reviews were conducted monthly. Five hundred sixty-six patients underwent bowel resection with anastomosis during the study period.

Discussion

One hundred ninety-three patients suffered at least one complication (34.1%) and there were 20 deaths (3.5%). In 17 cases, death was deemed unavoidable due to patient disease; most occurred in patients who developed ischemic bowel while hospitalized for a serious concomitant illness. In only one case did death appear clearly related to a surgical complication (0.17%). Death after bowel resection typically reflects the need for urgent surgery in extreme circumstances and not surgeon error. Postoperative mortality rate in this population appears to be poor indicator of surgical quality.

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Authors and Affiliations

  1. Department of Surgery, University of Vermont College of Medicine, Fletcher Allen Health Care, Fletcher House 301, 111 Colchester Avenue, Burlington, VT, 05401, USA

    Neil H. Hyman, Peter A. Cataldo, Elizabeth H. Burns & Steven R. Shackford

  2. Medical Center Hospital of Vermont, Department of Surgery, University of Vermont College of Medicine, Fletcher 301, 111 Colchester Avenue, Burlington, VT, 05401, USA

    Neil H. Hyman

Authors
  1. Neil H. Hyman
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  2. Peter A. Cataldo
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  3. Elizabeth H. Burns
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  4. Steven R. Shackford
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Corresponding author

Correspondence to Neil H. Hyman.

Additional information

Podium presentation at the American Society of Colon and Rectal Surgeons Annual Meeting, Boston, MA, June 2008.

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Hyman, N.H., Cataldo, P.A., Burns, E.H. et al. Death after Bowel Resection: Patient Disease, Not Surgeon Error. J Gastrointest Surg 13, 137–141 (2009). https://doi.org/10.1007/s11605-008-0609-5

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  • DOI: https://doi.org/10.1007/s11605-008-0609-5

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