Hospital-level Variation in Secondary Complications After Surgery

Area of Science:

• Healthcare Quality Improvement
• Surgical Outcomes Research
• Patient Safety

Background:

• Failure to rescue, or death after a postoperative complication, is a critical challenge in healthcare quality improvement.
• Secondary complications, arising after an initial complication, offer insights into rescue failures and potential targets for intervention.

Purpose of the Study:

• To evaluate hospital rates of secondary complications as potential performance benchmarks.
• To examine the association between secondary complication rates and patient mortality.

Main Methods:

• Utilized data from the American College of Surgeons' National Surgical Quality Improvement Program (2008-2012).
• Defined hospital rates of secondary complications following five common index complications: pneumonia, surgical site infection (SSI), urinary tract infection, transfusion/bleeding events, and acute myocardial infarction (MI).
• Categorized hospitals into quintiles based on risk- and reliability-adjusted secondary complication rates for comparison with mortality data.

Main Results:

• Significant variation in secondary complication rates was observed across hospitals, ranging from 22.93% to 57.99% after index pneumonia and 14.81% to 58.98% after index SSI.
• Hospitals with the highest rates of secondary complications exhibited significantly greater mortality across several index complications, including pneumonia (10.41% vs 6.20%), MI (18.25% vs 9.65%), and SSI (2.75% vs 0.82%).

Conclusions:

• Hospital-level rates of secondary complications demonstrate wide variability.
• These rates are significantly associated with patient mortality.
• Secondary complication rates may serve as valuable metrics for quality improvement initiatives and performance benchmarking in surgical care.