Complications Are Not Best Predictor


Good hospitals are better at
rescuing patients with complication;
© G. Altmann/

The report confirms that serious complications are common after major surgery – about one in six patients – but the study shows what drives hospital mortality is failure to rescue. In spite of similar patterns of complications, patients at high mortality hospitals are nearly twice as likely to die after developing a serious post-surgical complication, according to the study.

“The general assumption has been that high mortality hospitals simply have higher complication rates. We were quite surprised to find that that this is not true,” says study author John D. Birkmeyer. “Our finding was what distinguishes high quality hospitals and low quality hospitals is how proficient they are at rescuing people once a complication has happened,” he says.

The study used data on 84,730 patients undergoing general and vascular surgery at 186 hospitals. The mortality rate at hospitals varied dramatically from 3.5 percent at the best hospitals to 6.9 percent at the very high mortality hospitals. But there was not much difference in how many complications happened at these hospitals. Very high and very low mortality hospitals had similar rates of major complications – 18.2 percent vs. 16.2 percent.

But at low mortality hospitals only 12.5 percent of patients died from those complications, while at high mortality hospitals 21.4 percent of patients died. The study found similar patterns in the outcomes of specific complications. For example, very high mortality hospitals had similar rates of postoperative bleeding compared to other hospitals, but patients were 50 percent more likely to die if bleeding occurred.

”We have a number of hypotheses about why some hospitals may be better than others in rescuing patients,” says Birkmeyer. “Early recognition of a potential problem is crucial and may be related to the quality and quantity of nursing staff and relationships among team members - for example, whether nurses are afraid to call the doctor at night.”

Hospitals performing high risk surgery should have adequate resources for ensuring timely and effective treatment once complications are recognized. They should have doctors in house after hours, rapid response teams, and surgical ICUs managed by board certified intensivists, according to the researchers.; Source: University of Michigan Health System