RNS: Surgical complications, October 2009
TIME: 2:21
URL: http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1305
U-M Health Minute: Today’s top health issues and medical research
New study finds ability to rescue patients after complications best predictor of hospital mortality
About 1 in 6 patients has a serious surgical complication, but complication rates not the best marker of hospital quality
Suggested lead: Hospital mortality rates following in-patient surgery vary widely across the country. Previously, researchers attributed this to differing post-surgical complication rates at the highest mortality hospitals versus the lowest. A new national study at the University of Michigan, published in the current issue of the New England Journal of Medicine, demonstrates that this is not the case. Here is Andi McDonnell with more.
A compelling University of Michigan Health System study debunks assumptions about the role of complications in distinguishing good and bad hospitals.
The report in the October 1st, 2009 issue of the 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 rates is failure to rescue.
The best 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.
Dr. John D. Birkmeyer, (M.D.), professor of surgery and chair of surgical outcomes research at U-M Medical School explains . . .
“It’s important to understand why patients die after surgery in the first place. They go from having an uneventful course after their operation to having that first complication, that first domino that subsequently leads to other complications that gets them into the ICU, that leads to multi-system organ failure and ultimately to death. We found no evidence that hospitals varied in the likelihood that patients had that first domino, that first complication. Instead, the low mortality hospitals were much more proficient in keeping people from suffering more complications and from ultimately dying after they had that first complication.”
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.
Birkmeyer tells us . . .
“The implications for those findings is it gives us a much better sense about where we should be looking if we hope to fix the problem of high mortality rates with surgery. Rather than focusing only on what the surgeon does in the operating room, we need to focus on what’s happening in the wards and in the ICU after surgery.”
This is a new view of what defines the safest hospitals for surgery.
Andi McDonnell U-M Health System News.
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