Evaluating health care: what can hospital separation data tell us about the complications of hospital care?

The New South Wales (NSW) Health Department is attempting to refocus the health system towards examination of the outcomes of health interventions. Increased use of existing State-wide databases to measure outcomes of services is an important part of the reorientation of the health system. Complications of hospital care is one indicator of the quality and outcomes of health services. This study analyses surgical complications occurring in NSW residents admitted to hospital during 1989/90. Over 20,000 complications were recorded during this time (corresponding to a rate of 30/1000 surgical procedures). The most common complication recorded was postoperative infection. 71% of complications occurred during a surgical admission, while 29% of complications were associated with a readmission to hospital. While the incidence of complications could be estimated, there were substantial problems with the interpretation of the data which severely limited their potential usefulness. The implications of these results for the ongoing evaluation of the quality and outcomes of hospital care are discussed.