BACKGROUND: The rates of post-discharge deaths after surgical procedures are unknown and may represent areas of quality improvement. The NSQIP database captures 30-d outcomes not included within normal administrative databases, and can thus differentiate between in-hospital and post-discharge deaths. METHODS: Retrospective analysis of NSQIP from 2005 through 2007. Inclusion criteria were procedures whose median length of stay was greater than 1 d (to exclude outpatient procedures), and whose overall death rate was greater than 2% (to include only procedures where mortality was a significant issue). Procedures where less than 25 deaths occurred were excluded (for sample size concerns). RESULTS: There were 363,897 patients with 2236 different CPT codes captured in NSQIP. There were 6395 deaths; among them, 1486 (23.2%) occurred after discharge. Thirty-eight CPT codes met the analysis threshold. In two of the CPT codes, there were no post-discharge deaths (repair of ruptured abdominal aortic aneurysm [AAA], repair of ruptured AAA involving iliacs). In the other 36 CPT codes, the proportion of deaths occurring after discharge ranged from 6.3% (repair of thoracoabdominal aneurysm) to 50.0% (femoral-distal bypass with vein). The highest percentage of post-discharge mortality occurs on d 1 after discharge. Fifty percent of post-discharge mortality occurs by d 7; 95% occurs by d 21. CONCLUSION: Approximately one-fourth of postoperative deaths occur after hospital discharge. There is significant variation across surgical procedures in the likelihood of postoperative deaths occurring after discharge. These data indicate a need for closer and more frequent monitoring of post-surgical patients. These data also call into question conclusions drawn from hospital-based outcomes analyses for at least some key diseases/procedures. This analysis demonstrates the power of the risk-adjusted 30-d follow-up NSQIP data, but perhaps more importantly, the responsibility of surgeons to monitor and optimize the discharge process.
BACKGROUND: The rates of post-discharge deaths after surgical procedures are unknown and may represent areas of quality improvement. The NSQIP database captures 30-d outcomes not included within normal administrative databases, and can thus differentiate between in-hospital and post-discharge deaths. METHODS: Retrospective analysis of NSQIP from 2005 through 2007. Inclusion criteria were procedures whose median length of stay was greater than 1 d (to exclude outpatient procedures), and whose overall death rate was greater than 2% (to include only procedures where mortality was a significant issue). Procedures where less than 25 deaths occurred were excluded (for sample size concerns). RESULTS: There were 363,897 patients with 2236 different CPT codes captured in NSQIP. There were 6395 deaths; among them, 1486 (23.2%) occurred after discharge. Thirty-eight CPT codes met the analysis threshold. In two of the CPT codes, there were no post-discharge deaths (repair of ruptured abdominal aortic aneurysm [AAA], repair of ruptured AAA involving iliacs). In the other 36 CPT codes, the proportion of deaths occurring after discharge ranged from 6.3% (repair of thoracoabdominal aneurysm) to 50.0% (femoral-distal bypass with vein). The highest percentage of post-discharge mortality occurs on d 1 after discharge. Fifty percent of post-discharge mortality occurs by d 7; 95% occurs by d 21. CONCLUSION: Approximately one-fourth of postoperative deaths occur after hospital discharge. There is significant variation across surgical procedures in the likelihood of postoperative deaths occurring after discharge. These data indicate a need for closer and more frequent monitoring of post-surgical patients. These data also call into question conclusions drawn from hospital-based outcomes analyses for at least some key diseases/procedures. This analysis demonstrates the power of the risk-adjusted 30-d follow-up NSQIP data, but perhaps more importantly, the responsibility of surgeons to monitor and optimize the discharge process.
Authors: Jessica Spence; Yannick LeManach; Matthew TV Chan; C Y Wang; Alben Sigamani; Denis Xavier; Rupert Pearse; Pablo Alonso-Coello; Ignacio Garutti; Sadeesh K Srinathan; Emmanuelle Duceppe; Michael Walsh; Flavia Kessler Borges; German Malaga; Valsa Abraham; Atiya Faruqui; Otavio Berwanger; Bruce M Biccard; Juan Carlos Villar; Daniel I Sessler; Andrea Kurz; Clara K Chow; Carisi A Polanczyk; Wojciech Szczeklik; Gareth Ackland; Garg Amit X; Michael Jacka; Gordon H Guyatt; Robert J Sapsford; Colin Williams; Olga Lucia Cortes; Pierre Coriat; Ameen Patel; Maria Tiboni; Emilie P Belley-Côté; Stephen Yang; Diane Heels-Ansdell; Michael McGillion; Simon Parlow; Matthew Patel; Shirley Pettit; Salim Yusuf; P J Devereaux Journal: CMAJ Date: 2019-07-29 Impact factor: 8.262
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