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Impact of procedure-related complications on patient outcome on a general medicine service
M D Nettleman1, M J Bock, A P Nelson
1University of Iowa College of Medicine, Iowa City.
Objective:
To determine the importance of procedure-related complications on a general medical service.
Design:
A retrospective cohort study with one-to-one matching. Complications were identified through chart review by nurse-technicians using standard definitions.
Setting:
The internal medicine service of a 900-bed university hospital.
Patients:
One hundred seven cases with noninfectious, procedure-related complications and 107 closely matched controls who underwent the same procedures without complication.
Interventions:
None.
Measurements And Main Results:
The mortality rate was 28% for cases compared with 11% for controls, resulting in an excess mortality rate of 17% (p = 0.02). Cases who survived to discharge had an excess length of stay of seven days (p = 0.001). The excess cost per case was $12,913. Importantly, median reimbursement was only $2,064 higher for cases than for controls. Adjusting for age and APACHE II (severity of illness) score, procedure-related complications were associated with a 3.4-fold increase in the relative risk of in-hospital mortality (95% CI: 1.5 to 7.7). Surveillance data were useful in directing quality improvement activities that resulted in a 66% reduction in the rate of pneumothorax following thoracentesis.
Conclusions:
Procedure-related complications were associated with prolonged and expensive hospitalization and were a marker for patients at high risk for in-hospital mortality. Programs to reduce complications on the general medical service have an enormous potential to benefit both patients and hospitals.