CONTEXT: Complications are common in the care of trauma patients and contribute to morbidity, mortality, and cost. However, no comprehensive list of surgical complications is widely accepted. OBJECTIVES: To create an empirical list of complications based on the International Classification of Diseases, Ninth Revision (ICD-9) lexicon and estimate the contribution of these complications to mortality. DESIGN: Retrospective database analysis. SETTING: Office of Statewide Health Planning and Development data set. PATIENTS: The Office of Statewide Health Planning and Development provided information on 409,393 patients admitted to 1 of 159 California hospitals between 2004 and 2008. We defined a complication to be any ICD-9- coded condition that accrued after hospital admission and significantly increased mortality. MAIN OUTCOME MEASURES: Odds of mortality for individual complications and number of excess deaths due to individual complications based on attributable risk fractions. RESULTS: Eighty-two different ICD-9 codes contributed significantly to mortality as complications. Odds ratios ranged from 1.02 (hyperosmolarity) to 46.1 (ventricular fibrillation). There were a total of 175,299 complications (range, 0-14; average 0.4/patient). Twenty-four percent of patients had at least 1 complication. Mortality increased with the number of complications; each additional complication increased mortality by 8%. Absent any complications, there would have been 7292 fewer deaths, a 64% reduction in overall mortality. CONCLUSIONS: Most complication-related mortality is due to 25 individual complications. Eliminating all complications might prevent two-thirds of deaths, but because many complications are not preventable, this figure is the upper bound on possible mortality reduction. Hospitals vary in their proportions of deaths due to complications, and thus, efforts to prevent complications might improve survival at some hospitals.
CONTEXT: Complications are common in the care of traumapatients and contribute to morbidity, mortality, and cost. However, no comprehensive list of surgical complications is widely accepted. OBJECTIVES: To create an empirical list of complications based on the International Classification of Diseases, Ninth Revision (ICD-9) lexicon and estimate the contribution of these complications to mortality. DESIGN: Retrospective database analysis. SETTING: Office of Statewide Health Planning and Development data set. PATIENTS: The Office of Statewide Health Planning and Development provided information on 409,393 patients admitted to 1 of 159 California hospitals between 2004 and 2008. We defined a complication to be any ICD-9- coded condition that accrued after hospital admission and significantly increased mortality. MAIN OUTCOME MEASURES: Odds of mortality for individual complications and number of excess deaths due to individual complications based on attributable risk fractions. RESULTS: Eighty-two different ICD-9 codes contributed significantly to mortality as complications. Odds ratios ranged from 1.02 (hyperosmolarity) to 46.1 (ventricular fibrillation). There were a total of 175,299 complications (range, 0-14; average 0.4/patient). Twenty-four percent of patients had at least 1 complication. Mortality increased with the number of complications; each additional complication increased mortality by 8%. Absent any complications, there would have been 7292 fewer deaths, a 64% reduction in overall mortality. CONCLUSIONS: Most complication-related mortality is due to 25 individual complications. Eliminating all complications might prevent two-thirds of deaths, but because many complications are not preventable, this figure is the upper bound on possible mortality reduction. Hospitals vary in their proportions of deaths due to complications, and thus, efforts to prevent complications might improve survival at some hospitals.
Authors: Patrick T Lee; Laura K Krecko; Stephanie Savage; Ann P O'Rourke; Hee Soo Jung; Angela Ingraham; Ben L Zarzaur; John E Scarborough Journal: J Trauma Acute Care Surg Date: 2022-04-08 Impact factor: 3.697
Authors: Clementina Duran Palma; Musawenkosi Mamba; Johan Geldenhuys; Oluwafolajimi Fadahun; Rolf Rossaint; Kai Zacharowski; Martin Brand; Óscar Díaz-Cambronero; Javier Belda; Martin Westphal; Ute Brauer; Dirk Dormann; Tamara Dehnhardt; Martin Hernandez-Gonzalez; Sonja Schmier; Dianne de Korte; Frank Plani; Wolfgang Buhre Journal: Trials Date: 2022-06-02 Impact factor: 2.728
Authors: Emily Earl-Royal; Elinore J Kaufman; Jesse Y Hsu; Douglas J Wiebe; Patrick M Reilly; Daniel N Holena Journal: J Surg Res Date: 2016-07-05 Impact factor: 2.192
Authors: Elizabeth Warnack; Hersch Leon Pachter; Beatrix Choi; Charles DiMaggio; Spiros Frangos; Michael Klein; Marko Bukur Journal: JMIR Hum Factors Date: 2019-09-26