Deaths Following Cholecystectomy and Herniotomy: An Analysis of Nationwide German Hospital Discharge Data From 2009 to 2013.
BACKGROUND
In 2010, 158 000 cholecystectomies and 207 000 herniotomies (without bowel surgery) were performed in Germany as inpatient procedures, generally on a routine, elective basis. Deaths following such operations are rare events. We studied the potential association of death after cholecystectomy or herniotomy with risk factors that could have been detected beforehand, and we examined the types of complications that were documented in these cases.


METHODS
Using nationwide hospital discharge data (DRG statistics) for the years 2009-2013, we analyzed the characteristics of patients who died in the hospital after undergoing a cholecystectomy for cholelithiasis or the repair of an inguinal, femoral, umbilical, or abdominal wall hernia. We compared these data with those of patients who survived and studied the impact of the coded comorbidities on the risk of death.


RESULTS
In Germany, in the years 2009-2013, there were 2957 deaths after a total of 731 000 cholecystectomies (in-hospital mortality, 0.4%) and 1316 deaths after a total of 1 023 000 herniotomies without bowel surgery (0.13%). The patients who died were markedly older than those who did not, and they more commonly had comorbidities. Factors associated with a higher risk of death were age over 65 years, and comorbidities such as congestive heart failure, chronic pulmonary or hepatic disease, or poor nutritional status. Complications were coded much more often for the patients who died than for those who did not.


CONCLUSIONS
These findings suggest that there is potential for improvement in preoperative risk identification, complication avoidance, and the early recognition and treatment of complications, as well as in safe surgical technique. Measures to lower the mortality associated with herniotomy and cholecystectomy would lessen patients' individual risk and thereby improve patient safety.
Department of Structural Advancement and Quality Management in Health Care, Technische Universität Berlin.
Ulrike
U
Nimptsch
Thomasy
T
Mansk
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000401:mortality*; D002769:Cholelithiasis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006547:Hernia / Q000401:mortality*; D059685:Herniorrhaphy / Q000401:mortality*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D063886:Patient Discharge Summaries / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality*; D015995:Prevalence; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D055815:Young Adult