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Uncertain progress in Swiss perioperative mortality 1998-2014 for 22 operation groups
Johannes Wacker1, Marcel Zwahlen2
1Institute of Anaesthesia and Intensive Care, Hirslanden Clinic, Zurich, Switzerland.
Swiss Medical Weekly
|March 25, 2019
Summary
Perioperative mortality rates (POMR) remained unchanged or increased for most surgical procedures in Switzerland between 1998 and 2014. This trend highlights the need for continuous monitoring and quality improvement strategies in healthcare.
Area of Science:
- Healthcare quality assessment
- Surgical outcomes research
- Public health surveillance
Background:
- Perioperative mortality rate (POMR) serves as a critical quality indicator for healthcare systems.
- National in-hospital mortality rates for indicator operations (IORs) are published by the Swiss Federal Office of Public Health.
- This study investigated long-term time trends of POMRs from 1998-2014, anticipating decreases due to advancements in perioperative care.
Purpose of the Study:
- To analyze long-term time trends of perioperative mortality rates (POMRs) for various indicator operations (IORs) in Switzerland from 1998 to 2014.
- To assess whether perioperative mortality rates have decreased, remained unchanged, or increased over the study period.
- To categorize IORs based on POMR trends and risk levels to inform quality improvement strategies.
Main Methods:
- Included 22 non-cardiosurgical IORs with aggregated age- and sex-specific data on operations and deaths.
- Calculated age-standardized POMRs using the 2013 European Standard Population.
- Assessed calendar time trends of POMRs using multivariable Poisson regression and categorized IORs by trend and risk level.
Main Results:
- A total of 1,561,012 operations and 22,140 deaths were analyzed (crude POMR 1.42%).
- POMR trends decreased for 6 IORs (26.8% of operations), remained unchanged for 13 IORs (56.9%), and increased for 3 IORs (16.4%).
- Significant sex-based differences in POMR were observed for hysterectomy and transurethral resection of the prostate, and other operations.
Conclusions:
- The majority of indicator operations (73%) in Switzerland showed unchanged or increasing in-hospital POMR trends from 1998-2014.
- While age-standardization was applied, the analysis could not account for changes in coding practices or healthcare delivery organization.
- Systematic national-level monitoring of POMR trends is crucial for guiding quality improvement initiatives.
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