Thirty-day postoperative death rate at an academic medical center.
OBJECTIVE
To improve understanding of perioperative deaths at an academic medical center.


BACKGROUND
Because published data have typically focused on specific patient populations, diagnoses, or procedures, there are few data regarding surgical deaths and complications in institutional or regional studies. Specifically, surgical adverse events and errors are generally not studied comprehensively. This limits the overall understanding of complications and deaths.


METHODS
Data from all operations performed in the main operating suite of the University of Virginia Health Sciences Center from January 1 to June 30, 1999, were compared with state death records to gain a dataset of patients dying within 30 days of surgery. All clinical records from patients who died were screened for adverse events and subsequently reviewed by three surgeons who identified adverse events and errors and performed comparisons with survivors.


RESULTS
One hundred nineteen deaths followed 7,379 operations performed on 6,296 patients, yielding a patient death rate of 1.9%. Patients dying within 30 days of surgery were older and had higher American Society of Anesthesiologists scores. Of 119 deaths, 86 (72.3%) were attributable to the patient's primary disease. Twenty-three patient deaths (19.3% of all deaths, 0.37% of all patients) could not be attributed to the patient's primary disease and thus were suspicious for an adverse event (AE) as the cause of the death. Of the 23 deaths suspicious for AE, 15 (12.6% of all deaths, and 65.2% of AE deaths) followed an error in care and thus were classified as potentially preventable, affecting 0.24% of the study population.


CONCLUSIONS
Overall, the 30-day postoperative death rate was low in the total surgical population at an academic medical center. Errors and AEs were associated with 12.6% and 19.3% of deaths, respectively. Retrospective review inadequately characterized the nature of AEs and failed to determine causality. Prospective audits of outcomes will enhance our understanding of surgical AEs.
Calland
J Forrest
JF
Department of Surgery, University of Virginia Health Systems, Charlottesville, Virginia 22908, USA.
Adams
Reid B
RB
Benjamin
Daniel K
DK
O'Connor
Matthew J
MJ
Chandrasekhara
Vinay
V
Guerlain
Stephanie
S
Jones
Rayford Scott
RS
D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D016208:Databases, Factual; D006801:Humans; D015994:Incidence; D008485:Medical Audit / Q000706:statistics & numerical data; D019300:Medical Errors / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D011184:Postoperative Period; D013997:Time Factors