Using a National Representative Sample to Evaluate the Integrity of the 30-Day Surgical Mortality Metric

Area of Science:

• Healthcare Quality Measurement
• Surgical Outcomes Research
• Health Services Research

Background:

• The 30-day surgical mortality metric is crucial for value-based purchasing.
• Concerns exist regarding potential hospital manipulation of this measure through palliative care designation and patient selection.
• Ensuring the integrity of quality metrics is vital for accurate healthcare performance evaluation.

Purpose of the Study:

• To investigate potential manipulation of the 30-day surgical mortality metric.
• To assess if hospitals inappropriately alter patient care or selection to improve their 30-day mortality rates.
• To determine if a significant increase in mortality between postoperative days 26-30 and 31-35 indicates manipulation.

Main Methods:

• Retrospective analysis of 1,725,291 surgical admissions from 158 US hospitals (2010-2011).
• Comparison of post-operative mortality rates between postoperative day 26-30 and day 31-35.
• Statistical analysis using Wilcoxon signed-rank tests with Bonferroni correction.

Main Results:

• No statistically significant increase in mortality was observed after postoperative day 30 across the studied hospitals.
• The analysis did not reveal evidence of manipulation of the 30-day surgical mortality metric.
• The integrity of the 30-day surgical mortality measure was not compromised in this cohort.

Conclusions:

• The 30-day surgical mortality metric appears robust against manipulation within this study's scope.
• Current practices do not show evidence of gaming the system through end-of-life care or patient selection.
• Further research may be warranted to continually monitor and validate healthcare quality metrics.