Managing complications key to curbing mortality rates, study suggests

Complications themselves are less significant for predicting hospital mortality, while recognizing and managing complications play as great a role in death rates, according to new research.

Using 2005 to 2007 data from the American College of Surgeons National Surgical Quality Improvement Program, researchers studied more than 84,000 patients who had undergone inpatient general and vascular surgery. Hospitals were divided into quintiles based on their risk-adjusted overall death rates and studied complications, major complications and mortality for each group.

Hospitals with both very low—3.5%—and very high—6.9%—mortality rates had similar rates of overall and major complications. However, patients with major complications died more frequently at hospitals with very high mortality rates, according to the study, “Variation in Hospital Mortality Associated with Inpatient Surgery,” published in the Oct. 1 New England Journal of Medicine.

Researchers found similar case mixes for hospitals at both the high and low end of mortality rates. Instead of just focusing on reducing complications at hospitals, providers should also be considering how best to identify and manage complications when they occur in their efforts to ensure a patient survives after surgery, the researchers said. “The quality of nursing care is clearly central to such communication and may explain previous studies that showed an association between a high nurse-to-bed ratio and low surgical mortality,” the researchers wrote.

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