Outcome measurement using hospital activity data: deaths after surgical procedures

There is a pressing need to develop measures of health outcome for use in medical audit and in shaping decisions on the allocation of resources. Such measurement is not normally performed except in specific research settings. Routine information collected on hospital inpatients contains very crude data on two health outcomes, namely whether such patients were alive or dead at the end of their hospital stay. This paper analyses hospital activity data with particular reference to those patients who had undergone a surgical procedure. The results are broadly consistent with the earlier findings of the Confidential Enquiry into Perioperative Deaths and reveal a crude mortality rate of under 15 deaths per 1000 surgical admissions. Rates as high as 280 per 1000 admissions were found for certain procedures. Since death is a relatively rare health outcome it is argued that the development of a more acceptable measure must be a priority to provide information on the vast majority of surgical patients with non-fatal outcomes.