NSQIP Reveals Significant Incidence of Death Following Discharge

Yu, Peter T.; Chang, David C.; Osen, Hayley; Talamini, Mark A.

doi:10.1016/j.jss.2011.05.040

Cited by 26 publications

(20 citation statements)

References 10 publications

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“…21 By contrast, a review of the American College of Surgeons National Surgical Quality Improvement Project database (which captures a broad American surgical population with the exclusion of minor procedures) found an overall mortality rate of 1.76% and an in-hospital mortality rate of 1.35%. 22 Perioperative morbidity, length of stay, and hospital charges were also greater in the ACHD cohort.…”

Section: Discussionmentioning

confidence: 90%

Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

et al. 2013

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Background: An increasing number of patients with congenital heart disease are surviving to adulthood. Consensus guidelines and expert opinion suggest that noncardiac surgery is a high-risk event, but few data describe perioperative outcomes in this population. Methods: By using the Nationwide Inpatient Sample database (years 2002 through 2009), the authors compared patients with adult congenital heart disease (ACHD) who underwent noncardiac surgery with a non-ACHD comparison cohort matched on age, sex, race, year, elective or urgent or emergency procedure, van Walraven comborbidity score, and primary procedure code. Mortality and morbidity were compared between the two cohorts. Results: A study cohort consisting of 10,004 ACHD patients was compared with a matched comparison cohort of 37,581 patients. Inpatient mortality was greater in the ACHD cohort (407 of 10,004 [4.1%] vs. 1,355 of 37,581 [3.6%]; unadjusted odds ratio, 1.13; P = 0.031; adjusted odds ratio, 1.29; P < 0.001). The composite endpoint of perioperative morbidity was also more commonly observed in the ACHD cohort (2,145 of 10.004 [21.4%] vs. 6,003 of 37,581 [16.0%]; odds ratio, 1.44; P < 0.001). ACHD patients comprised an increasing proportion of all noncardiac surgical admissions over the study period (P value for trend is <0.001), and noncardiac surgery represented an increasing proportion of all ACHD admissions (P value for trend is <0.001). Conclusions: Compared with a matched control cohort, ACHD patients undergoing noncardiac surgery experienced increased perioperative morbidity and mortality. Within the limitations of a retrospective analysis of a large administrative dataset, this finding demonstrates that this is a vulnerable population and suggests that better efforts are needed to understand and improve the perioperative care they receive.

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Section: Discussionmentioning

confidence: 90%

Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

et al. 2013

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“…Furthermore, the average length of hospital stay has decreased significantly in the past few decades and may therefore have shifted mortality away from the hospital to post-discharge destinations. 13 14 A recent study by Yu et al (2011) showed that for certain surgical procedures approximately a quarter of postoperative deaths occurred after discharge and that 12% took place just one day after discharge from hospital. 15 Metersky et al (2012) concluded that approximately 50% of older patients who died from pneumonia within 30 days of admission did not die in hospital but after discharge.…”

Section: Introductionmentioning

confidence: 99%

“…13 14 A recent study by Yu et al (2011) showed that for certain surgical procedures approximately a quarter of postoperative deaths occurred after discharge and that 12% took place just one day after discharge from hospital. 15 Metersky et al (2012) concluded that approximately 50% of older patients who died from pneumonia within 30 days of admission did not die in hospital but after discharge. 16 We will refer to this phenomenon as "early post-discharge mortality."…”

Section: Introductionmentioning

confidence: 99%

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Including post-discharge mortality in calculation of hospital standardised mortality ratios: retrospective analysis of hospital episode statistics

Pouw

Peelen

Moons

et al. 2013

BMJ

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Objectives To assess the consequences of applying different mortality timeframes on standardised mortality ratios of individual hospitals and, secondarily, to evaluate the association between in-hospital standardised mortality ratios and early post-discharge mortality rate, length of hospital stay, and transfer rate.Design Retrospective analysis of routinely collected hospital data to compare observed deaths in 50 diagnostic categories with deaths predicted by a case mix adjustment method. Main outcome measuresIn-hospital standardised mortality ratio, 30 days post-admission standardised mortality ratio, and 30 days post-discharge standardised mortality ratio.Results Compared with the in-hospital standardised mortality ratio, 33% of the hospitals were categorised differently with the 30 days post-admission standardised mortality ratio and 22% were categorised differently with the 30 days post-discharge standardised mortality ratio.A positive association was found between in-hospital standardised mortality ratio and length of hospital stay (Pearson correlation coefficient 0.33; P=0.01), and an inverse association was found between in-hospital standardised mortality ratio and early post-discharge mortality (Pearson correlation coefficient −0.37; P=0.004). ConclusionsApplying different mortality timeframes resulted in differences in standardised mortality ratios and differences in judgment regarding the performance of individual hospitals. Furthermore, associations between in-hospital standardised mortality rates, length of stay, and early post-discharge mortality rates were found. Combining these findings suggests that standardised mortality ratios based on in-hospital mortality are subject to so-called "discharge bias." Hence, early post-discharge mortality should be included in the calculation of standardised mortality ratios. IntroductionIn the past few decades, quality of care in hospitals has been subject to growing attention from physicians and regulators. In various countries, standardised mortality ratios are used in an

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“…Many surgeons think of PAC as a transitional phase before returning home, but the increased mortality during this period challenges this assertion. Twenty-three percent of postoperative deaths occur after discharge [9], 59.3%–74.4% of deaths after traumatic injury occur after discharge [10,11], and 85.7% of elderly trauma patient deaths occur after leaving the hospital [12]. Population and hospital-based cohort studies have consistently demonstrated worse survival for intensive care unit, surgical, and trauma patients discharged to SNFs: risk of death is 1.6–3.9 times greater for patients discharged to SNF compared with those discharged home [10,11,13-18].…”

Section: Introductionmentioning

confidence: 99%

Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review

Hakkarainen

Ayoung-Chee

Alfonso

et al. 2015

Journal of Surgical Research

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Background The surgical population is aging, and greater numbers of surgical patients are being discharged to skilled nursing facilities. Post-acute care is a poorly understood but very important aspect of our healthcare system. Methods This systematic review examines the current body of literature surrounding the structural, process of care, and outcomes measurements for patients in skilled nursing facilities. English language articles published between 1998 and 2011 that purposed to examine nursing facility structure, process of care, and/or outcomes were included. Results & Conclusions Abstracts (2129) were screened and 102 articles were reviewed in full. Twenty-nine articles were included in the qualitative synthesis. The role of the care setting and care delivery in contributing to outcomes has not been well studied, and no strong conclusions can be made. This area of care currently represents a “black box” to practicing surgeons. An understanding of these factors maybe instrumental to determining future directions for research to maximize positive outcomes for these patients.

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NSQIP Reveals Significant Incidence of Death Following Discharge

Cited by 26 publications

References 10 publications

Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

Perioperative Outcomes of Major Noncardiac Surgery in Adults with Congenital Heart Disease

Including post-discharge mortality in calculation of hospital standardised mortality ratios: retrospective analysis of hospital episode statistics

Structure, process, and outcomes in skilled nursing facilities: understanding what happens to surgical patients when they cannot go home. A systematic review

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