Tuesday, October 20, 2009
The assumption is that high mortality hospitals have high complication rates. But a new report, Variation in Hospital Mortality Associated with Inpatient Surgery, 361 N.Eng. J. Med. 1368-75 (2009), shows complications are common after major surgery -- about one in six patients. What distinguishes good and bad hospitals is how proficient they are at rescuing patients from those complications. Patients at high mortality hospitals are twice as likely to die from a post-surgical complication. The story in ScienceDaily explains:
The report in Thursday's New England Journal of Medicine confirms that serious complications are common after major surgery – about 1 in 6 patients – but the study shows what drives hospital mortality is failure to rescue.
Low mortality hospitals have medical teams with the ability to rescue patients by recognizing and heading off potentially catastrophic complications such as deep wound infections, pneumonia, kidney failure, blood clots, and strokes.
In spite of similar patterns of complications, patients at high mortality hospitals are nearly twice as likely to die after developing a serious post-surgical complication, according to the study. It's a new view of what defines the safest hospitals for surgery.
"The general assumption has been that high mortality hospitals simply have higher complication rates. We were quite surprised to find that that's not true," says study author John D. Birkmeyer, M.D., professor of surgery and chair of surgical outcomes research at U-M. "Our finding was what distinguishes high quality hospitals and low quality hospitals is how proficient they are at rescuing people once a complication has happened," he says.
The study used data on 84,730 patients undergoing general and vascular surgery at 186 hospitals participating in the American College of Surgeons – National Surgical Quality Improvement Program.