Nationwide rates and patterns of death after surgery are unknown.
Using the Nationwide Inpatient Sample, we compared deaths within 30 days of admission for patients undergoing surgery in 1996 and 2006. International Classification of Diseases codes were used to identify 2,520 procedures for analysis. We examined the inpatient 30-day death rate for all procedures, procedures with the most deaths, high-risk cardiovascular and cancer procedures, and patients who suffered a recorded complication. We used logistic regression modeling to adjust 1996 mortality rates to the age and gender distributions for patients undergoing surgery in 2006.
In 1996, there were 12,573,331 admissions with a surgical procedure (95% confidence interval [CI], 12,560,171-12,586,491) and 224,111 inpatient deaths within 30 days of admission (95% CI, 221,912-226,310). In 2006, there were 14,333,993 admissions with a surgical procedure (95% CI, 14,320,983-14,347,002) and 189,690 deaths (95% CI, 187,802-191,578). Inpatient 30-day mortality declined from 1.68% in 1996 to 1.32% in 2006 (P < .001). Of the 21 procedures with the most deaths in 1996, 15 had significant declines in adjusted mortality in 2006. Among these 15 procedures, 8 had significant declines in operative volume. The inpatient 30-day mortality rate for patients who suffered a complication decreased from 12.10% to 9.84% (P < .001).
Nationwide reporting on surgical mortality suggests that the number of inpatient deaths within 30 days of surgery has declined. Additional research to determine the underlying causes for decreased mortality is warranted.
"Recent studies report that since the late 1990s mortality rates have declined among patients who undergo high-risk surgery procedures in the United States, despite increases in the number of operations performed [1,2]. In spite of this improvement, there are inherent risks associated with any surgery, and complications, including death, may occur [3-6]. "
[Show abstract][Hide abstract] ABSTRACT: Background
High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid.
Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis.
Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings.
Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.
BMC Palliative Care 06/2014; 13:32. DOI:10.1186/1472-684X-13-32 · 1.78 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The primary focus of this review is on the cost-effectiveness of critical care. The rapid growth in health care expenditures has engendered careful scrutiny of the practice of medicine with regard not only to effectiveness but also to efficiency. This shift necessitates that physicians understand the effectiveness of their interventions and the cost at which this effectiveness is obtained. Cost-effectiveness and cost-utility analyses have become crucial evaluative tools in medicine. Explicit articulation of comparative cost-effectiveness facilitates the allocation of limited resources. Physicians and policy-makers must evaluate such studies with caution, skepticism, and attention to the methods used.
Surgical Clinics of North America 12/2012; 92(6):1445-62. DOI:10.1016/j.suc.2012.09.001 · 1.88 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Checklists are increasingly being used by surgical teams in the perioperative period to improve clinical care and increase patient safety. In this article, we review some of the mechanisms by which checklists work and evaluate evidence supporting their use.
There is a growing body of evidence showing the importance of team-based checklists in clinical care. In multiple complex clinical environments, from the operating room to the intensive care unit, checklists can help ensure adherence to known standards of care and improve communication amongst team members. In addition, the efficacy of checklists is being shown in both developed and developing settings.
Checklists can aid clinicians involved in complex processes and multidisciplinary team interactions to improve the quality and safety of care by prompting dialogue and exchange of information.
Canadian Anaesthetists? Society Journal 12/2012; 60(2). DOI:10.1007/s12630-012-9854-x · 2.53 Impact Factor
Rizwan A Manji, Rakesh C Arora, Rohit K Singal, Brett Hiebert, Michael C Moon, Darren H Freed, Alan H Menkis
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