Study examines postdischarge complications after general surgery
A study of postdischarge (PD) complications after general surgery procedures found that overall, 16.7 percent of patients experienced a complication and 41.5 percent of complications occurred PD, according to a report published in the November issue of Archives of Surgery.
The immediate PD period is a vulnerable time for patients, and there are clinical and economic costs to patients and the health care system when patients have to be rehospitalized because of complications. The Patient Protection and Affordable Care Act has said reducing avoidable rehospitalization is a target for cost savings, according to the study background.
Hadiza S. Kazaure, M.D., of Stanford University, Palo Alto, Calif., and colleagues evaluated procedure-specific types, rates and risk factors for PD complications occurring within 30 days after 21 groups of inpatient general surgery procedures. Researchers utilized American College of Surgeons National Surgical Quality Improvement Program 2005 through 2012 participant use data files in the study, which included 551,510 patients (average age nearly 55 years).
"We found that more than 40 percent of all post-operative complications occurred PD; approximately 1 in 14 general surgery patients who underwent an inpatient procedure experienced a PD complication," the authors comment.
Proctectomy (14.5 percent, surgery involving the rectum), enteric fistula repair (12.6 percent, abnormal passageway repair) and pancreatic procedures (11.4 percent) had the highest PD complication rates. Breast, bariatric and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7 percent, 69.4 percent and 62 percent, respectively), according to the study results.
For all procedures, researchers note that surgical site complications, infections and thromboembolic (blood clot) events were the most common. An inpatient complication increased the likelihood of a PD complication (12.5 percent vs. 6.2 percent without an inpatient complication). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6 percent vs. 17.9 percent, respectively) and death (2 percent vs. 6.9 percent, respectively) within 30 days after surgery. Those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7 percent) and death (24.7 percent), according to the study results.
"In summary, our analysis revealed that PD complications account for a significant burden of postoperative complications and are an important avenue for quality improvement in inpatient general surgery," the authors conclude. "More research is needed to develop and explore the utility of a cost-effective and fastidious PD follow-up system for surgical patients."
In an invited critique, Desmond C. Winter, M.D., of St. Vincent's University Hospital, Dublin, Ireland, writes: "Every surgeon will read the article by Kazaure et al with interest as complications are the statistics that define us all."
"Reducing morbidity was the driving force behind the scientific evolution of surgical departments. From ether and carbolic acid, penicillin and insulin to modern minimally invasive advances, the imperative was to enhance patient safety, not to satisfy economists. Insurers and surgeons should remind themselves to whom the moral debt of professional courtesy is owed," Winter continues.
"Patient needs, not financial penalties, should be everyone's primary focus. Let us see further advancements in surgical care through research funded by the proposed insurer savings and together strive for safer surgery," Winter concludes.
More information: Arch Surg. 2012; 147:1000-1007
Arch Surg. 2012;147:1007-1008
Journal reference: JAMA Surgery
Provided by JAMA and Archives Journals
- General surgeons identify postoperative complications posing strongest readmission risk Aug 28, 2012 | not rated yet | 0
- Study examines hospital complication rates of bariatric surgery Jul 27, 2010 | not rated yet | 0
- Do-not-resuscitate orders associated with poor surgical outcomes even for non-emergency procedures Apr 18, 2011 | not rated yet | 0
- Men more prone to complications after brain, spine surgery Apr 20, 2012 | not rated yet | 0
- Open surgical and minimally invasive hernia repair techniques compared Mar 19, 2012 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Indeterminism in Classical Physics
32 minutes ago I was reading the Roger Penrose book Emperor's New Mind and he was explaining the determinism in Newtonian mechanics. He says that if we consider...
Current in two wires
1 hour ago Wire A and B, which have the same cross-sectional area are connected in series. There is a p.d. V across the whole wire. Suppose the two wires...
understanding the dipole model for Rayleigh scattering
3 hours ago Hello. I am currently studying scattering theory in detail for my BSc thesis, and I'm starting with Rayleigh scattering. I'm following Scattering...
question on coriolis effect with drag force
8 hours ago I really need help with this question. A small floating object initially moves with velocity v on the surface of a liquid at latitude λ. The...
Question of reflection and transmission of TEM wave in normal incidenc
14 hours ago Suppose TEM wave in +z normal to a boundary on xy plane at z=0. We know *E* & *H* are tangential to the boundary. Let ##\vec E_i=\hat x E##, be the...
the rudyak-krasnolutski effective potencial
15 hours ago Hi ... anyone now how to calculate or the formula of the rudyak-krasnolutski EFFECTIVE potencial ? the effective potencial includes the angular...
- More from Physics Forums - Classical Physics
More news stories
Johns Hopkins researchers have developed new guidelines—the first in more than 35 years—to govern the amount of blood ordered for surgical patients. The recommendations, based on a lengthy study of blood use at The Johns ...
Surgery May 22, 2013 | 4 / 5 (1) | 0
Indian doctors said Wednesday they have successfully carried out a first round of reconstructive surgery on the skull of a baby suffering from a rare disorder that caused her head to nearly double in size.
Surgery May 22, 2013 | not rated yet | 0
A 33-year-old Polish man received a face transplant just three weeks after being disfigured in a workplace accident, in what his doctors said Wednesday is the fastest time frame to date for such an operation. ...
Surgery May 22, 2013 | not rated yet | 0
Surgeons investigated sexual function in 62 patients, 50 years and older, who had received extensive spinal–pelvic instrumentation for spinal deformity at the University of Virginia Health Center. Based on their results, ...
Surgery May 21, 2013 | not rated yet | 0
Physicians at Monash University and The Alfred Hospital in Melbourne, Australia describe the logistic, medical, and societal challenges faced in treating spine trauma in morbidly obese patients. Based on a case series of ...
Surgery May 21, 2013 | not rated yet | 0
The World Health Organization voiced deep concern Thursday over the SARS-like virus that has killed 22 people in less than a year, saying it might potentially spread more widely between humans.
58 minutes ago | 5 / 5 (1) | 0
(AP)—Researchers examining the incidence of brain cancer at jet engine manufacturer Pratt & Whitney in Connecticut say they have found no statistically significant elevations in the rate of cancer among workers.
48 minutes ago | not rated yet | 0
(Medical Xpress)—Regulating the distribution of power in neurons is done by a system that makes the national electric grid look simple by comparison. Each neuron has several thousand mitochondria confined ...
13 hours ago | 4.8 / 5 (6) | 0 |
Artemio Martinez balanced his corpulent frame on a stool in a Mexico City street taco stand, downing a sweet soda and eating a final pork-filled corn tortilla.
1 hour ago | not rated yet | 0
The British Menopause Society and Women's Health Concern have today released updated guidelines on Hormone Replacement Therapy (HRT) to provide clarity around the role of HRT, the benefits and the risks. The new guidelines ...
2 hours ago | not rated yet | 0
A brief visual task can predict IQ, according to a new study. This surprisingly simple exercise measures the brain's unconscious ability to filter out visual movement. The study shows that individuals whose ...
19 hours ago | 4.5 / 5 (10) | 1 |