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ECONOMICS AND HEALTH SYSTEMS RESEARCH

The Use of a Postoperative Morbidity Survey to Evaluate Patients with Prolonged Hospitalization After Routine, Moderate-Risk, Elective Surgery

E. Bennett-Guerrero, MD^*, I. Welsby, FRCA, T. J. Dunn, MD, L. R. Young, MD, T. A. Wahl, MD, T. L. Diers, MD, B. G. Phillips-Bute, PhD, M. F. Newman, MD, and M. G. Mythen, MD

*Department of Anesthesiology, The Mount Sinai Medical Center, New York, New York; Departments of Anesthesiology and Biostatistics, Duke University Medical Center, Durham, North Carolina; and Department of Anaesthesia, University College London Hospitals, London, England

Address correspondence and reprint requests to Elliott Bennett-Guerrero, MD, Department of Anesthesiology, P&S Box 46, College of Physicians and Surgeons of Columbia University, 630 West 168th St., New York, NY 10032.

Vital healthcare resources are devoted to caring for patients with prolonged hospitalization after routine, moderate-risk surgery. Despite the significant cost, little is known about the overall incidence and pattern of complications in these patients. Four hundred thirty-eight patients undergoing a diverse group of routine, moderate-risk, elective surgical procedures were enrolled into a prospective, blinded, cohort study. Complications were assessed using a postoperative morbidity survey. The main outcome was postoperative complication, defined as either in-hospital death or prolonged postoperative hospitalization (>7 days). The mortality rate was 1.6%. Postoperative complications occurred in 118 patients (27% [95% CI 23–31]). Complications frequently observed in these patients included: gastrointestinal 51% (42–60), pulmonary 25% (17–33), renal 21% (14–28), and infectious 13% (7–19). Most complications were not directly related to the type/site of surgery. Indices of tissue trauma (blood loss [P < 0.001], surgical duration [P = 0.001]) and tissue perfusion (arterial base deficit [P = 0.008], gastric pHi [P = 0.02]) were the strongest intraoperative predictors of complications. Despite a low mortality rate, we found that complications after routine, moderate-risk, elective surgery are common and involve multiple organ systems. Our 9-point survey can be used by healthcare providers and payers to characterize postoperative morbidity in their respective settings.

Implications: Little is known about the overall incidence and pattern of complications in patients with prolonged hospitalization after routine, elective surgery. We prospectively assessed these complications using a novel postoperative morbidity survey. The postoperative morbidity survey can be used in future clinical outcome trials, as well as in routine hospital-based quality assurance.

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