Surgical Deaths Linked to Handling of Complications

Staffing and hospital culture play a role, expert contends

By Ed Edelson
HealthDay Reporter

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WEDNESDAY, Sept. 30 (HealthDay News) -- The way that a hospital handles the complications of surgery, not just the rate of those complications, determines the hospital's surgical death rate, a new study has found.

The study, which included more than 84,000 people who had surgery in U.S. hospitals, found about a twofold difference in surgical deaths between hospitals with the lowest rate and those with the highest -- 3.5 percent vs. 6.9 percent. This occurred despite a small difference in the overall rate of complications -- 24.6 percent in the hospitals with the lowest surgical mortality rate and 26.9 percent in those with the highest.

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The emphasis in recent years has been on reducing the rate of surgical complications, said Dr. Justin B. Dimick, assistant professor of surgery at the University of Michigan and a co-author of the study, published in the Oct. 1 issue of the New England Journal of Medicine. Many hospitals have established point-by-point checklists that surgeons go through before operating.

"Our study doesn't necessarily contradict the need for checklists," Dimick said. "There is no doubt that reducing complications is an important goal. But our data show that the reason why some hospitals aren't reducing mortality may be due to differences in the complication treatment."

To some degree, complications are inevitable in surgery, Dimick said. "We're most worried about the complications that can lead to death," he said. "About one of every six patients has complications that can lead to death."

Complications can be related to the surgery itself, including bleeding, infections and leakages, Dimick said, and they can be related to medical problems that the person having surgery might have, such as a heart attack, blood clots in the leg, kidney failure or stroke.

In hospitals with low mortality rates, 12.5 percent of people with such complications died, the study found. The death rate in the highest-mortality hospitals was 21.4 percent.

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