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The zero mortality paradox in surgery.

Justin B Dimick1, H Gilbert Welch

  • 1VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, VT 05009, USA.

Journal of the American College of Surgeons
|December 25, 2007
PubMed
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Hospitals reporting zero surgical deaths for three years do not have lower mortality rates in subsequent years. A zero mortality history is not a reliable indicator of future surgical outcomes for patients.

Area of Science:

  • Health Services Research
  • Surgical Outcomes
  • Hospital Performance Metrics

Background:

  • Patients often assume zero operative mortality indicates superior surgical care.
  • This perception may lead patients to choose hospitals based on historical zero mortality rates.

Purpose of the Study:

  • To investigate if hospitals with zero operative mortality over three years maintain lower mortality rates in the subsequent year.
  • To determine the reliability of zero mortality as a predictor of future hospital performance.

Main Methods:

  • Analysis of national Medicare data for five high-mortality procedures (1997-2000).
  • Identification of 'zero mortality hospitals' with no deaths from 1997-1999.
  • Comparison of subsequent year (2000) mortality rates between zero mortality hospitals and other hospitals.

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Main Results:

  • For four procedures, mortality rates in zero mortality hospitals were similar to or higher than other hospitals.
  • Pancreatic cancer resection showed substantially higher mortality in zero mortality hospitals (11.2%) versus others (8.7%).
  • Zero mortality hospitals did not demonstrate better subsequent-year outcomes for the procedures studied.

Conclusions:

  • Hospitals with a prior zero mortality record do not consistently show better surgical outcomes.
  • Reported zero operative mortality should not be solely relied upon by patients selecting surgical facilities.
  • Rethinking the use of zero mortality as a sole performance indicator is warranted.