Mortality during surgery is dependent on two factors. The first is the probability of having complications during surgery. The second is the probability of dying conditional on having a complication. One would expect that hospitals with low mortality rates would have both fewer complications and lower probability of death conditional on a complication.
A paper by Gheferi, Birkmeyer, and Dimick (NEJM 2009) shows that this may not be the case. After risk adjustment complication rates were not significantly higher in high mortality hospitals. However, conditional on there being a complication, mortality rates were much higher in high mortality hospitals than low mortality hospitals.
How can doctors decrease mortality due to complications? Gheferi, Birkmeyer, and Dimick recommend “timely administration of antibiotics in patients with sepsis, the rapid transfer of a patient to an intensive care unit (ICU), and the availability of interventional cardiologists during an acute myocardial infarction.”
- Gheferi, Birkmeyer, and Dimick (2009) “Variation in Hospital Mortality Associated with Inpatient Surgery” NEJM, 361(14):1368-1375.