Deaths from Surgery Greater than Estimated

A study has found that the risk of death associated with elective surgery is far greater than previously estimated and often more than 10%. Conducted by researchers from Dartmouth Medical School (Hanover, NH, USA) and the White River Junction Veterans Administration (VA) Medical Center (VT, USA), the study was reported in the July/August 2001 issue of Effective Clinical Practice.

The Dartmouth researchers examined mortality in 1.2 million patients hospitalized between 1994 and 1999 for 14 high-risk elective surgeries, using the file of the National Medicare claims database for patients aged 65 and older. They found that carotid endarterectomy had the lowest overall operative mortality (1.3%), while the highest overall mortality (8.6% to 13.7%) was found for removal of all or part of the stomach, esophagus, and lung, and major pancreatic resection. Operative mortality is defined as death before discharge or within 30 days of the operation.

The study showed that the mortality risk increases with age, and that operative deaths for patients 80 years and older was more than twice that for patients 65-69 years old. The researchers found that operative mortality for major surgery is considerably higher than that typically reported in case series and trials of operative mortality. Information about mortality risks is essential for patients considering elective major surgery.

"Both surgeons and patients need to be aware that operative mortality depends strongly on patient factors, particularly age,” said John Birkmeyer, M.D., associate professor of surgery at Dartmouth Medical School. "Elderly patients often have risks two- to four-fold higher than younger patients. Mortality risks also depend on where the surgery is performed. Unfortunately, some hospitals have much higher mortality rates than others.”




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