Navigation Links
Surgical Deaths Linked to Handling of Complications
Date:9/30/2009

Staffing and hospital culture play a role, expert contends,,

WEDNESDAY, Sept. 30 (HealthDay News) -- The way that a hospital handles the complications of surgery, not just the rate of those complications, determines the hospital's surgical death rate, a new study has found.

The study, which included more than 84,000 people who had surgery in U.S. hospitals, found about a twofold difference in surgical deaths between hospitals with the lowest rate and those with the highest -- 3.5 percent vs. 6.9 percent. This occurred despite a small difference in the overall rate of complications -- 24.6 percent in the hospitals with the lowest surgical mortality rate and 26.9 percent in those with the highest.

The emphasis in recent years has been on reducing the rate of surgical complications, said Dr. Justin B. Dimick, assistant professor of surgery at the University of Michigan and a co-author of the study, published in the Oct. 1 issue of the New England Journal of Medicine. Many hospitals have established point-by-point checklists that surgeons go through before operating.

"Our study doesn't necessarily contradict the need for checklists," Dimick said. "There is no doubt that reducing complications is an important goal. But our data show that the reason why some hospitals aren't reducing mortality may be due to differences in the complication treatment."

To some degree, complications are inevitable in surgery, Dimick said. "We're most worried about the complications that can lead to death," he said. "About one of every six patients has complications that can lead to death."

Complications can be related to the surgery itself, including bleeding, infections and leakages, Dimick said, and they can be related to medical problems that the person having surgery might have, such as a heart attack, blood clots in the leg, kidney failure or stroke.

In hospitals with low mortality rates, 12.5 percent of people with such complications died, the study found. The death rate in the highest-mortality hospitals was 21.4 percent.

"Not much attention has been paid to the management of complications," he said. "That is where we should be looking."

The pattern could be seen in management of specific complications. For example, all the hospitals had roughly similar incidences of post-surgery bleeding. But the death rate from that complication was 50 percent higher in some hospitals than in others.

Though the new study does not directly address ways to manage surgical complications, "we can speculate," Dimick said. "A number of things in previous studies have been associated with mortality."

Hospitals with lower surgical death rates tend to have fully-staffed, 24-hour intensive care units with physicians trained to handle post-surgical emergencies. They have high nurse-to-patient ratios in their intensive care units and their wards. "The more nurses the better because there are fewer patients per nurse," Dimick said.

A less tangible factor -- "just the culture of the hospital" -- also is involved, he said. "Do people feel afraid to call the surgeon at night, are they afraid to go up the chain of command, are they not afraid of pushing the button?"

Dr. Peter Pronovost, a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine, said that the study's findings don't lessen the need to prevent surgical complications and errors. Pronovost was an originator of the checklist concept.

"We have to try to prevent complications when we can," he said. "But when we can't, we must make sure that they are properly recognized and treated. This study shows that recognition and treatment has a substantial impact on a patient's risk of dying."

Studies already have shown that the availability of intensive care specialists and a high nurse-to-patient ratio improve survival, but that lesson is sometimes forgotten in current cost-cutting times, Pronovost said.

"We may have slipped a bit in that area because the workload is often quite high," he said.

More information

The U.S. Agency for Healthcare Research and Quality has information on what you need to know before surgery.



SOURCES: Justin B. Dimick, M.D., M.P.H., assistant professor, surgery, University of Michigan, Ann Arbor, Mich.; Peter Pronovost, M.D., Ph.D., professor, anesthesiology and critical care medicine, Johns Hopkins University School of Medicine, Baltimore; Oct. 1, 2009, New England Journal of Medicine


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. New study shows promise in reducing surgical risks associated with surgical bleeding
2. Pioneer Surgical Technology Hires Vice President of New Business Development
3. Symmetry Medical Completes Acquisition Of Specialty Surgical Instruments
4. Innocoll Agrees the Sale of its CollaRx(R) GENTAMICIN SURGICAL IMPLANT and European Sales and Marketing Infrastructure to EUSA Pharma
5. Revolutionary HD Surgical Footage from North Shore-LIJ Surgeon to be Broadcast for the First Time on ABCs 20/20, National Geographic Channel
6. American Heart Association Surgical Supplement Journal Report: Appropriate Hospital Discharge System Can Prevent Future Cardiac Events
7. MAKO Surgical Corp. Names Frederic H. Moll, M.D. to Board of Directors
8. Study finds limiting work hours for surgical residents enhances training
9. STAAR Surgical Reports Operational Progress
10. Stille and Enova Form Strategic Partnership to Introduce Worlds Brightest LED Cordless Surgical Headlights Into Europe and Japan
11. PEAK Surgical Announces Positive Surgical Incision Wound Healing Results With the PEAK PlasmaBlade(TM)
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:1/20/2017)... , ... January 20, 2017 , ... “Mary Magdalene: Grace ... mysterious life of the woman who witnessed Jesus Christ firsthand. “Mary Magdalene: Grace is ... who spent her career as an educator interacting with countless women who had little ...
(Date:1/20/2017)... , ... January 20, 2017 , ... “Christmas in Suffolk”: ... of published author, Sara Seymour, who lives in Lafayette, Indiana where she works in ... on iced coffees and writes. , Published by Christian Faith Publishing, Sara Seymour’s new ...
(Date:1/19/2017)... , ... January 20, 2017 , ... Today, the Centers ... participate in four of CMS’s Alternative Payment Models (APMs) in 2017. Clinicians who participate ... APMs are an important part of the Administration’s effort to build a system ...
(Date:1/19/2017)... , ... January 19, 2017 , ... This month, the ... that the name of their drug rehab center in Delray Beach, Florida has been ... that not only stars such as Philip Seymour Hoffman and Chris Farley are dying ...
(Date:1/19/2017)... ... 19, 2017 , ... WholeHealth is announcing their participation in ... Andrew Petersen and Trish Henrie-Barrus will be present Saturday and Sunday in the ... , “We know it’s easy to get carried away when you’re having ...
Breaking Medicine News(10 mins):
(Date:1/20/2017)... 20, 2017 Research and Markets has ... (by Devices, Implant Types, OTC Amplifiers, Diagnostic Instruments), Sales Volume, ... offering. ... Global Hearing Aids Market Sales Volume, Company Analysis and Forecast ... hearing aid industry. The growing prevalence of hearing ...
(Date:1/20/2017)... , January 20, 2017 Stock-Callers.com ... (NASDAQ: SGYP ), Novo Nordisk A/S (NYSE: ... ), and Pernix Therapeutics Holdings Inc. (NASDAQ: PTX ... on Thursday, January 19 th , 2017, finishing near its ... Care Index dropped over 0.7%, while shares of health care ...
(Date:1/20/2017)...  Palladian Health, a leading provider of quality ... an opioid management program which assists physicians in ... stem the growing tide of dependence on prescription ... non-cancer pain (back pain, neck pain, and degenerative ... evidence regarding long-term effectiveness. The new ...
Breaking Medicine Technology: