Variations in complication rates and opportunities for improvement in quality of care for patients having abdominal aortic surgery.
BACKGROUND
The purpose was to assess the current variation in complication rates and evaluate the association between specific types of complications and in-hospital mortality and total hospital charges for patients having abdominal aortic surgery.


METHODS
We studied 2987 patients for abdominal aortic surgery in Maryland from 1994 to 1996 and used discharge diagnoses and procedure codes to identify diagnoses that most likely represent major surgery complications. We evaluated how in-hospital mortality and total hospital charges related to specific complications, adjusting for patient demographics, severity of illness, comorbidity, and hospital and surgeon volumes. Discharge data was obtained from the hospital marketing departments.


RESULTS
Complication rates varied widely among hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest with an odds ratio (OR) of 90 and a 95% confidence interval (CI) of 32-251, septicemia (OR 6.1, CI 3.3-11.3), acute myocardial infarction (OR 5.7, CI 2.3-14.3), acute renal failure (OR 5.0, CI 2.3-11.0), surgical complications after a procedure (OR 3.1, CI 2.0-4.9), and reoperation for bleeding (OR 2.2, CI 1.1-4.8). The population-attributable risk for in-hospital mortality was 47% for cardiac arrest and 27% for acute renal failure.


CONCLUSIONS
In abdominal aortic surgery on patients in Maryland, the rates of some complications vary widely and are independently associated with increased in-hospital mortality and hospital charges (charges differ from costs). Efforts to reduce these complications should help to decrease both levels.
Pronovost
P
P
Department of Anesthesiology/CCM, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Meyer 297A, Baltimore, MD 21287-7294, USA. ppronovo@jhmi.edu
Garrett
E
E
Dorman
T
T
Jenckes
M
M
Webb III
T H
TH
Breslow
M
M
Rosenfeld
B
B
Bass
E
E
D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D016015:Logistic Models; D008396:Maryland / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology*; D011787:Quality of Health Care; D012307:Risk Factors; D012720:Severity of Illness Index