Variation in hospital mortality associated with inpatient surgery.
Approach to Improving Safety
Setting of Care
Significant variation in mortality rates between hospitals after certain surgeries has been documented since the 1970s. The patient safety approach to improving surgical outcomes has largely focused on reducing preventable complications, such as a landmark study that successfully reduced complication rates by implementing a standardized checklist of safe surgical practices. This study used data from the National Surgical Quality Improvement Program to examine whether mortality after surgery was also influenced by "failure to rescue"—failure to recognize and treat complications. Although complication rates were largely similar across hospitals, patients in lower-performing hospitals were almost twice as likely to die of a complication. Prior research has demonstrated that optimal nurse staffing ratios and use of intensivists may be associated with improved surgical outcomes, and the authors advocate for examining the role of hospital organizational factors in reducing preventable surgical mortality.