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Background:
The ostensible goal of participating in quality improvement programs is to improve surgical outcomes. Our hospital has been submitting data since 2006.
Purpose:
To assess whether systematic review of deaths with specific feedback to surgeons can influence behavior and improve mortality rates.
Methods:
Our hospital participates in NSQIP. Status reports are provided on a quarterly basis. The hospital is ranked based on calculation of the observed versus expected rate. Surgeons are given feedback on their performance and identification of opportunities for improvement is done.
Results:
We reviewed our results from 4 consecutive years: 2010 to 2013. In 2011, the mortality rate was 0.71% for general surgery (9 of 1268), 3.8% for colorectal (7 of 180) and 4.5% for vascular (14 of 310). This resulted in decreasing the hospital ranking to the 9^th decile. Detailed analysis revealed that the median age at death was 79.5 years. There were 8 women (26%). Nearly half the deaths occurred due to futile care or failure to rescue after a life-threatening complication in the postoperative period. In several cases, the families of these patients elected to withdraw support in the first week postoperatively. The results were shared with vascular and general surgeons. In 2012, mortality was decreased by half.
Conclusion:
Surgeons are frequently pressured to operate on moribund patients whose chances of survival are dismal. Analysis of our hospital mortality rate revealed that many deaths were attributed to futile care or failure to rescue. By sharing this information with multiple disciplines and early engagement of hospice, a significant decrease in mortality has been achieved.