The value of a mortality-scoring system in the quality control of patients undergoing abdominal aortic surgery.
OBJECTIVE
to assess the quality of care of patients undergoing abdominal aortic surgery.


METHODS
three hundred and forty-six patients undergoing surgery for aneurysmal or occlusive disease of whom 51 died.


METHODS
we developed a mortality registration system to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between clinical diagnosis and necropsy findings.


RESULTS
the main cause of death for 11 patients (22%) was a poor clinical condition at admission, while 76% (n=39) of the patients died due to postoperative complications. Myocardial infarction was the most frequently encountered complication. Deficiencies in medical treatment were observed in 10 of the 51 deaths (20%). Autopsy was performed in 33 of the 51 patients (65%), revealing in 10 cases (30%) a major discrepancy between pre- and postmortem findings. Six of the 10 autopsies revealed that a myocardial infarction had been missed during the postoperative period.


CONCLUSIONS
autopsy reports are essential for accurately estimating complication rates as we observed discrepancies in 30% of cases.
Vrancken Peeters
M P
MP
Department of Surgery, Red Cross Hospital, The Hague, The Netherlands.
Kappetein
A P
AP
Lardenoye
J H
JH
Breslau
P J
PJ
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D011786:Quality Control; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000592:standards*