Study: Postoperative complications are a major concern for hospitals

A recent study sheds new light on the prevalence of postoperative complications.

In November 2016, a study published in the British Journal of Anesthesia (BJA) found that each year there are 50 million postop complications worldwide. Those complications in turn result in 1.5 million deaths. That’s a worldwide average of 16.8% of surgeries resulting in a postop complication and 2.8% of those complications resulting in death before a patient left the hospital. Researchers used data on 44,814 patients who underwent surgery within the same seven-day period, comparing different types of surgery with the frequency and severity of adverse outcomes. The patients came from 474 different hospitals in 27 different countries, ranging between high income (U.S., U.K., Germany) and low income (Uganda, Brazil, Romania).

The study found that the postop complication mortality rate for patients in high-income nations was 2.6%. Meanwhile in low-/middle-income countries the mortality rate is 3.3%. Which means that when a patient in the U.S. experiences a complication due to surgery, their odds of survival are only 0.7% better than if they were treated in another country.  

Plus, patients in high-income countries were more likely to experience complications at all at 19% compared to 11% in low- and middle-income countries. Researchers theorized the difference may be because high-income nations offer surgery to higher-risk patients who are older, frailer, or have long-term diseases like diabetes or heart failure. 

"These findings should serve as a wake-up call,” wrote BJA Editor-in-Chief Ravi Majahan. “We need to do more to prevent postsurgery complications—and particularly complications such as infection which are in many cases preventable, but as this research suggests are claiming the lives of three quarters of a million people worldwide, every year."

The BJA study actually found that the most common surgical complications in the world are infectious complications, particularly superficial site infections, which affect 28 million (9%) patients. Meanwhile, cardiovascular complications affect 4.5% of all patients and have the highest risk of mortality. And upper gastrointestinal surgeries were found to run the greatest risk of complications.

James Rickert, MD, president of the Society for Patient Centered Orthopedics, says most facilities do fairly well at preventing postop complications. That said, there’s always room for improvement. One such area is care coordination after discharge, he says. 

“A study in Health Affairs in 2013 found wide variation in ER use among facilities after surgical patient discharge,” he says. “Suggesting that some institutions could do a much better job with discharge planning and care coordination to keep their postop patients out of the ER by preventing problems.”

Bradley T. Truax, MD, principal consultant of the Truax Group, is board-certified in both neurology and internal medicine and has been involved in patient safety for more than 25 years. He says that types of surgical complications vary depending on the type of surgery being undergone. However, he notes that deep vein thrombosis (DVT, also known as blood clots) and infections are common and serious postoperative complications. 

“[Complication rates] vary by type of surgery,” he says. “Outpatient hand surgery or arthroscopic surgery have very low rates of complications; less than 1%. Extensive in-patient surgeries, such as vascular surgery, carries a higher rate of complications. [And] extensive surgeries like tumor surgery or big trauma cases might have a complication rate as high as 30%; however, the surgery is potentially lifesaving.” 

Surgical site infections (SSI) are an increasing concern amongst the healthcare industry due to the rise in antimicrobial-resistance (AMR). In the U.S., drug-resistant diseases have caused 23,000 deaths and 2 million illnesses, and cost the healthcare industry between $27 billion to $42 billion annually. Rickert says surgeons are likely to see a considerable impact from AMRs in upcoming years on patient health and safety. To keep surgery patients safe, facilities and staff will have to exercise good antibiotic stewardship, he says, and following evidence-based guidelines for their proper use is critical.

The best way to prevent these and other complications, he says, is following clinical practice guidelines and best practices published by surgical societies such as the American College of Surgeons. These tools are publicly available, he says, and deal with things such as proper DVT prophylaxis, and proper antibiotic coverage for elective and emergency surgery.  

“These guidelines should be followed unless there is a good reason not to do so,” Rickert says. 

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