A new study from California suggests that 40% of post surgical complications occur after hospital discharge. The study, titled “Association of Postdischarge Complications With Reoperation and Mortality in General Surgery” was authored by Hadiza S. Kazaure, MD; Sanziana A. Roman, MD; and Julie A. Sosa, MD, MA.
The study followed 551,510 adult patients after general surgery. The average age of the patients was 54.6 years. They found that 16.7% of the patients had post surgery complications, with 41.5% happening after they were discharged from the hospital. The researchers found that 75% of these complications occurred within two weeks of leaving the hospital.
The procedures with the highest post discharge rates were prostectomy (at 14.5%), enteric fistula repair (at 12.6%) and pancreatic surgery (at 11.4%). When analyzing the complications by procedure, they found that three specific surgery areas had very high complication rates. 78.7% of breast surgeries had post discharge complications, 69.4% of bariatric surgeries had post discharge complications, and 62% of hernia repair surgeries had post discharge complications.
The most common causes of the complications were infection and blood clots. Those individuals who had post discharge complications had a 17.9% risk of reoperation, compared with 4.6% of patients who had no problems. They were also at a higher risk of death within 30 days after surgery, with 6.9% compared to 2.0% for no complications.
Those patients who experienced post surgery complications in the hospital and then other complications after discharge were at even higher risk. They faced a 33.7% chance of reoperation, and 24.7% risk of death.
The conclusion of the study found that post discharge rates, “vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve [post discharge] outcomes.”
The study invited a critique of the report by Desmond C. Winter, from St. Vincent’s University Hospital in Dublin, Ireland. He states that, “Complications are the statistics that define us all. Patient needs, not financial penalties, should be everyone’s primary focus. Let us see further advancements in surgical care through research funded by the proposed insurer savings and together strive for safer surgery.”
Read the study abstract at Archives of Surgery