Death after bowel resection: patient disease, not surgeon error.
BACKGROUND
Although bowel resection is associated with a significant mortality rate, little is known about the demographics of the patients and how often surgical error is the primary cause of death. We sought to use a rigorous prospective quality database incorporating standardized peer review, to define how often patients die from provider-related causes.


METHODS
All patients undergoing bowel resection with anastomosis at a university hospital from July 2003 to June 2006 were entered into a prospectively maintained quality database. Patients were seen daily with house staff by a specially trained nurse practitioner who recorded demographics and complications. Clinical case reviews were conducted monthly. Five hundred sixty-six patients underwent bowel resection with anastomosis during the study period.


CONCLUSIONS
One hundred ninety-three patients suffered at least one complication (34.1%) and there were 20 deaths (3.5%). In 17 cases, death was deemed unavoidable due to patient disease; most occurred in patients who developed ischemic bowel while hospitalized for a serious concomitant illness. In only one case did death appear clearly related to a surgical complication (0.17%). Death after bowel resection typically reflects the need for urgent surgery in extreme circumstances and not surgeon error. Postoperative mortality rate in this population appears to be poor indicator of surgical quality.
Hyman
Neil H
NH
Department of Surgery, University of Vermont College of Medicine, Fletcher Allen Health Care, Fletcher House 301, 111 Colchester Avenue, Burlington, VT 05401, USA. Neil.Hyman@vtmednet.org
Cataldo
Peter A
PA
Burns
Elizabeth H
EH
Shackford
Steven R
SR
D000368:Aged; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity / Q000639:trends; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality* / Q000601:surgery; D008297:Male; D019300:Medical Errors; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology