Context: For patients considering elective major surgery, information about operative mortality risks is essential for careful decision making. Because available information is often limited to educated guesses or optimistic data from case series, we examined surgical mortality by using nationwide data.
Practice pattern examined: Operative mortality in 1.2 million patients in the Medicare system who were hospitalized between 1994 and 1999 for major elective surgery (six cardiovascular procedures and eight major cancer resections).
Data source: MEDPAR file of the National Medicare claims database for patients 65 years of age and older.
Outcomes: Operative mortality, defined as death within 30 days of the operation or death before discharge.
Results: Overall operative mortality varied widely according to procedure. Procedures associated with relatively low mortality risk included carotid endarterectomy (1.3%) and nephrectomy (2.3%). Overall mortality was greater than 10% for other procedures, such as mitral valve replacement (10.5%), esophagectomy (13.6%), and pneumonectomy (13.7%). In general, mortality risk increased with age. Operative mortality for patients 80 years of age and older was more than twice that for patients 65 to 69 years of age.
Conclusion: Population-based operative mortality for major surgery varies by procedure and patient age and is considerably higher than that typically reported in case series and trials.