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. 2019 Nov 1;116(44):739-746.
doi: 10.3238/arztebl.2019.0739.

Mortality and Complications Following Visceral Surgery: A Nationwide Analysis Based on the Diagnostic Categories Used in German Hospital Invoicing Data

Philip Baum  1 , Johannes Diers, Sven Lichthardt, Carolin Kastner, Nicolas Schlegel, Christoph-Thomas Germer, Armin Wiegering
Affiliations

Mortality and Complications Following Visceral Surgery: A Nationwide Analysis Based on the Diagnostic Categories Used in German Hospital Invoicing Data

Philip Baum et al. Dtsch Arztebl Int. .

Abstract

Background: The in-hospital mortality after visceral surgery in Germany is unknown.

Methods: In this retrospective, descriptive analysis, nationwide hospital billing data based on diagnosis-related groups (DRG) over the period 2009-2015 were studied to determine the in-hospital mortality, complications and their management, and deaths after documented severe complications (failure to rescue, FTR) after visceral surgery in Germany. Organ-system subgroups were defined and subdivided into frequent operations (inguinal hernia repair, appendectomy, thyroid operations, cholecystec- tomy), colorectal operations, and complex operations (surgery of the esophagus, pancreas, liver, and stomach).

Results: 3 287 199 patients from 1392 hospitals were included in the analysis. The in-hospital mortality after visceral surgery was 1.9%. The lowest mortality was after the frequently performed operations (0.04-0.4%), the highest after complex surgery of the esophagus (8.6%) and stomach (11.7%). Severe complications were most commonly seen after complex surgery of the pan- creas (27.7%), liver (24.3%), esophagus (37.8%), and stomach (36.7%). 90.6% of deaths occurred after colorectal or complex operations, which together accounted for 23% of all operations. The FTR rate was 8.4% after appendectomy and cholecystec- tomy (95% confidence interval [8.34; 8.46]) and 20.3% after esophageal surgery ([19.8; 20.8]).

Conclusion: In Germany, in-hospital mortality after visceral surgery is not uncommon, with a frequency of nearly 2%. Improved complication management after complex operations appears necessary. A limitation of this study is the identification of compli- cations from anonymized billing data.

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Figures

Figure
Figure
Failure to rescue following visceral surgical procedures. The mean of the listed complication ± standard deviation per group is shown. Since colorectal procedures represent only one group, no standard deviation can be calculated. RBCC, red blood cell concentrate
See this image and copyright information in PMC

Comment in

  • Conclusions Are Speculative.
    Mroczkowski P. Mroczkowski P. Dtsch Arztebl Int. 2020 May 15;117(20):361. doi: 10.3238/arztebl.2020.0361a. Dtsch Arztebl Int. 2020. PMID: 32657749 Free PMC article. No abstract available.
  • Indications for Surgery Need to Be Assessed in a Differentiated Way.
    Ronellenfitsch U, Damirov F, Grilli M, Prechal D. Ronellenfitsch U, et al. Dtsch Arztebl Int. 2020 May 15;117(20):361-362. doi: 10.3238/arztebl.2020.0361b. Dtsch Arztebl Int. 2020. PMID: 32657750 Free PMC article. No abstract available.
  • Causes Need to Be Examined More Closely.
    Holzheimer R. Holzheimer R. Dtsch Arztebl Int. 2020 May 15;117(20):362. doi: 10.3238/arztebl.2020.0362a. Dtsch Arztebl Int. 2020. PMID: 32657751 Free PMC article. No abstract available.
  • Inaccuracies.
    Nimptsch U, Krautz C. Nimptsch U, et al. Dtsch Arztebl Int. 2020 May 15;117(20):362-363. doi: 10.3238/arztebl.2020.0362b. Dtsch Arztebl Int. 2020. PMID: 32657752 Free PMC article. No abstract available.

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