Perioperative deaths--detection by linkage of hospital discharge and death registration sub-files.

In support of the extension of the National Confidential Enquiry into Perioperative Deaths to Scotland, and in view of increased interest in the use of such deaths as clinical outcome measures in the setting of service contracts, methods have been developed employing the national Hospital Discharge (SMR1) file and Registrar General's Death Registration file on a local microcomputer for the identification of patients who die within 30 days of an operation. Direct interrogation of the SMR1 file for individual records containing both an operation date and date of death yields only those patients who die prior to discharge or transfer. Since in our study these accounted for only 52% of the total perioperative deaths, this may explain previous disillusionment with the potential of computer systems for their identification. By creating each month a SMR1 sub-file of patients having operations and linking this to a second sub-file containing the records of all patients dying in hospital, it was found that 32% of deaths occurred following transfer to a different specialty or hospital, and 8% on re-admission following discharge home. On linking the SMR1 operation sub-file to the death registration file, 8% of the total perioperative deaths were shown to have taken place outside hospital.