Measures of early postoperative mortality: beyond hospital fatality rates.
OBJECTIVE
To quantify the short term risk of postoperative mortality in ways which take account of deaths after discharge and the background risks of death in patients who come to operation.


METHODS
Analysis of linked abstracts of hospital admission records and death certificates for common operations.


METHODS
Six health districts in the Oxford region.


METHODS
Records of 223,529 operations performed in 1980-6.


METHODS
In hospital fatality rates, case fatality rates, and standardised mortality ratios at selected time periods during the year after operation and the ratio of early (< 30 days) to late (90-364 days after operation) fatality rates.


RESULTS
Fatality rates throughout the year after operations performed after emergency admissions were generally higher than those for similar operations performed after elective admissions and higher than expected from population rates. Examples were prostatectomy, hip arthroplasty, inguinal herniorrhaphy, and cholecystectomy. Common elective operations such as inguinal herniorrhaphy and cataract operations showed no early peak in mortality, but others did. These included transurethral prostatectomy (ratio of early to late mortality 2.0; 95% confidence interval 1.3 to 2.6), hysterectomy (3.2; 1.5 to 6.6), hip arthroplasty (3.8; 2.5 to 5.4), and cholecystectomy (6.9; 4.3 to 11.1).


CONCLUSIONS
Temporal profiles of death rates in the year after operation show which operations have early peaks in mortality and which do not. Emergency and elective operations have very different profiles and should be analysed separately. For elective operations for conditions which pose no immediate threat to life the ratio of early to later fatality rates provides a measure of increase in mortality after operation while allowing for the background risk of death in the patient groups.
Seagroatt
V
V
Department of Public Health and Primary Care, University of Oxford.
Goldacre
M
M
D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures / Q000401:mortality; D004630:Emergencies; D004739:England / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D011182:Postoperative Care / Q000401:mortality*; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate; D013997:Time Factors