W. T. Mehtsun1,3, J. F. Figueroa2,3,4, K. D. Lillemoe1,2, A. K. Jha2,3 1Massachusetts General Hospital,Department Of Surgery,Boston, MA, USA 2Harvard School Of Medicine,Brookline, MA, USA 3Harvard School Of Public Health,Department Of Health Policy And Management,Boston, MA, USA 4Brigham And Women’s Hospital,Department Of Medicine,Boston, MA, USA
Introduction: A recent series of national policy efforts, from public reporting to pay-for performance, has been implemented to improve surgical outcomes in U.S. hospitals. Whether these increased efforts have led to an observable decrease in surgical mortality rates remains unclear. Therefore, we sought to determine whether national 30-day mortality rates after complex and common surgeries are declining.
Methods: Using 100% inpatient Medicare-fee-for-service beneficiary data from 2005 to 2014, we identified patients undergoing the following complex and common surgical procedures: coronary artery by-pass graft (CABG), abdominal aortic aneurysm repair (AAA repair), esophagectomy, pancreatectomy, cystectomy, pulmonary lobectomy, colectomy, appendectomy, cholecystectomy, hip replacement, and knee replacement. For each procedure we used linear regression models with hospital fixed effects to calculate yearly 30-day surgical mortality rates – risk adjusted by age, gender, urgency and Elixhauser comorbidity indicators.
Results: Between 2005 and 2014, 30-day surgical mortality declined for all eleven selected procedures (N= 7,729,564). The greatest declines in 30-day surgical mortality were seen in patients who underwent esophagectomy (-0.23% per year, p<0.001), AAA repair (-0.18% per year, p<0.001), pancreatectomy (-0.19% per year, p<0.001), and pulmonary lobectomy (-0.14% per year, p<0.001). Notably, improvements were occurring mainly within hospitals, except for pancreactectomy, esophagectomy, and cystectomy where greater than 50% of the overall mortality trend was due to between hospital differences.
Conclusions: National 30-day surgical mortality rates for complex and common surgical procedures have declined over the past decade. Whether this national decline in surgical mortality is due to shifting of patients to higher quality hospitals, or general improvements in surgical management is unclear and needs to be better delineated.