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Defining operative mortality: Impact on outcome reporting
Steven Maximus1, Jeffrey C Milliken1, Beate Danielsen2
1Division of Cardiothoracic Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, Calif.
The Journal of Thoracic and Cardiovascular Surgery
|February 16, 2016
Summary
A significant percentage of procedural deaths occur post-discharge, particularly after percutaneous coronary intervention (PCI). Accurate reporting of operative mortality is crucial for clinical registries like the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
Area of Science:
- Cardiovascular Surgery
- Health Outcomes Research
- Medical Informatics
Background:
- Procedural mortality is a key outcome in cardiac interventions.
- Definitions of operative mortality have evolved, impacting outcome reporting.
- Recent definitions in the Society of Thoracic Surgeons Adult Cardiac Surgery Database include post-transfer and all-cause 30-day deaths.
Purpose of the Study:
- To assess the impact of redefined operative mortality metrics on outcome reporting.
- To quantify post-discharge deaths following cardiac procedures.
Main Methods:
- Utilized the California Office of Statewide Health Planning and Development database (2009).
- Analyzed isolated coronary artery bypass grafting (CABG), isolated valve, CABG-valve, and percutaneous coronary intervention (PCI) procedures.
- Employed five distinct methods for counting mortality, including in-hospital, connected hospitalization, and 30-day outcomes.
- Conducted two analyses: one excluding no patients, and one excluding untrackable patients.
Main Results:
- In the unexcluded analysis, 17% of surgical deaths and 31% of PCI deaths occurred post-hospitalization.
- Elective PCI showed the highest post-hospital death rate (45%).
- CABG procedures had the highest post-hospital death rate among surgical patients (20%).
- With untrackable patients excluded, hospital deaths were 4% for surgery and 12% for PCI.
Conclusions:
- A substantial proportion of procedural deaths occur after patients leave the initial hospital.
- This finding is particularly pronounced in percutaneous coronary intervention (PCI) procedures.
- Emphasizes the critical importance of standardized and accurate operative mortality definitions for clinical registries.
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