NSQIP reveals significant incidence of death following discharge

J Surg Res. 2011 Oct;170(2):e217-24. doi: 10.1016/j.jss.2011.05.040. Epub 2011 Jun 24.


Background: The rates of post-discharge deaths after surgical procedures are unknown and may represent areas of quality improvement. The NSQIP database captures 30-d outcomes not included within normal administrative databases, and can thus differentiate between in-hospital and post-discharge deaths.

Methods: Retrospective analysis of NSQIP from 2005 through 2007. Inclusion criteria were procedures whose median length of stay was greater than 1 d (to exclude outpatient procedures), and whose overall death rate was greater than 2% (to include only procedures where mortality was a significant issue). Procedures where less than 25 deaths occurred were excluded (for sample size concerns).

Results: There were 363,897 patients with 2236 different CPT codes captured in NSQIP. There were 6395 deaths; among them, 1486 (23.2%) occurred after discharge. Thirty-eight CPT codes met the analysis threshold. In two of the CPT codes, there were no post-discharge deaths (repair of ruptured abdominal aortic aneurysm [AAA], repair of ruptured AAA involving iliacs). In the other 36 CPT codes, the proportion of deaths occurring after discharge ranged from 6.3% (repair of thoracoabdominal aneurysm) to 50.0% (femoral-distal bypass with vein). The highest percentage of post-discharge mortality occurs on d 1 after discharge. Fifty percent of post-discharge mortality occurs by d 7; 95% occurs by d 21.

Conclusion: Approximately one-fourth of postoperative deaths occur after hospital discharge. There is significant variation across surgical procedures in the likelihood of postoperative deaths occurring after discharge. These data indicate a need for closer and more frequent monitoring of post-surgical patients. These data also call into question conclusions drawn from hospital-based outcomes analyses for at least some key diseases/procedures. This analysis demonstrates the power of the risk-adjusted 30-d follow-up NSQIP data, but perhaps more importantly, the responsibility of surgeons to monitor and optimize the discharge process.

MeSH terms

  • Aortic Aneurysm, Abdominal / mortality*
  • Aortic Aneurysm, Thoracic / mortality
  • Appendectomy / mortality
  • Cholecystectomy / mortality
  • Coronary Artery Bypass / mortality
  • Databases, Factual / statistics & numerical data*
  • Female
  • Hospital Mortality
  • Humans
  • Hysterectomy / mortality
  • Incidence
  • Length of Stay / statistics & numerical data
  • Male
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Patient Discharge / statistics & numerical data*
  • Postoperative Complications / mortality*
  • Retrospective Studies
  • Risk Factors
  • Transurethral Resection of Prostate / mortality
  • Vascular Surgical Procedures / mortality