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The value of a mortality-scoring system in the quality control of patients undergoing abdominal aortic surgery
M P Vrancken Peeters1, A P Kappetein, J H Lardenoye
1Department of Surgery, Red Cross Hospital, The Hague, The Netherlands.
Objectives:
to assess the quality of care of patients undergoing abdominal aortic surgery.
Materials:
three hundred and forty-six patients undergoing surgery for aneurysmal or occlusive disease of whom 51 died.
Methods:
we developed a mortality registration system to classify causes of death, to evaluate shortcomings in treatment, and to determine the extent of agreement between clinical diagnosis and necropsy findings.
Results:
the main cause of death for 11 patients (22%) was a poor clinical condition at admission, while 76% (n=39) of the patients died due to postoperative complications. Myocardial infarction was the most frequently encountered complication. Deficiencies in medical treatment were observed in 10 of the 51 deaths (20%). Autopsy was performed in 33 of the 51 patients (65%), revealing in 10 cases (30%) a major discrepancy between pre- and postmortem findings. Six of the 10 autopsies revealed that a myocardial infarction had been missed during the postoperative period.
Conclusions:
autopsy reports are essential for accurately estimating complication rates as we observed discrepancies in 30% of cases.