Percentage of patients with in-hospital death recorded within 30 days of surgery.

Over 2.3 million surgeries occur worldwide per year, making perioperative mortality ratios (POMR) an important metric of surgical and anesthetic safety.^3,4,6 Mortality rates can also identify failure to rescue in the healthcare system.^3,4,6,7  In hospital mortality rates within 30 days of surgery in the United States are estimated to have fallen from 1.64%-1.68% in 1996 to 1.14%-1.32% in 2006, however there is no consensus on acceptable POMR within 30 days or surgery or day of surgery.^2,5,6 Variance in 30 day POMR are indicative of overall health system and surgical safety, while variance in same day POMR are more likely to capture differences in decisions to operate, anesthetic and procedural care, and ability to care for a deteriorating patient intra and postoperatively.^1,3 POMR should be calculated as a ratio where the numerator is the number of patients who died within 30 days after a procedure and the denominator is all procedures/cases.^1,3,6 Calculating the ratio in this way represents the risk associated with each surgical case.³  This measure should not be used to compare institutions, but rather to guide quality improvement.⁶ 

Anesthesia Start to 30 days after Anesthesia End

All patients requiring anesthesia

• ASA 6 including Organ Procurement (CPT: 01990)
• Non-Index cases (see Other Measure Details)

Patients without an in-hospital death documented within 30 days after anesthesia

Post-procedure in-hospital mortality measured as:

# of cases with in-hospital death reported within 30 days of procedure (exclude subsequent cases, only count one case per pt) / total # of cases  (count all cases, do not exclude if multiple cases per pt)

• Patients with more than one procedure count once in the numerator, however each procedure counts in the denominator 

• Patients who are discharged from the hospital and are known to have died while readmitted within 30 days of the procedure will be included in this measure.
• Measures will be assigned the following results:
  • Passed - No known death
  • Passed - Known death >30 days
  • Flag - Death Within 30 days, Index Case
  • Excluded - Death Within 30 days, Not Index Case
  • Excluded - ASA 6
• For measure purposes, the following will be used in the calculation: 
  • Numerator: Flagged Cases
  • Denominator: 
    • Passed - No known death
    • Passed - Known death >30 days
    • Excluded - Death Within 30 days, Not Index Case
    • Flag - Death Within 30 days, Index Case
• Cases will be grouped by patient ID to support review of all cases for that patient, even outside of the 30 day period
• Index cases are the first chronological case within 30 days before death (excluding ASA 6 including Organ Procurement)
• Dates of death that precede the patient’s Last Known Alive date are not considered for this measure.

*This measure will include only valid MPOG cases as defined by the Is Valid Case phenotype.

Pending

Departmental only measure - not available for provider feedback emails.

References:

1. Ariyaratnam, Roshan, Charlotta L. Palmqvist, Phil Hider, Grant L. Laing, Douglas Stupart, Leona Wilson, Damian L. Clarke, Lars Hagander, David A. Watters, and Russell L. Gruen. 2015. “Toward a Standard Approach to Measurement and Reporting of Perioperative Mortality Rate as a Global Indicator for Surgery.” Surgery 158 (1): 17–26.
2. Semel, Marcus E., Stuart R. Lipsitz, Luke M. Funk, Angela M. Bader, Thomas G. Weiser, and Atul A. Gawande. 2012. “Rates and Patterns of Death after Surgery in the United States, 1996 and 2006.” Surgery 151 (2): 171–82.
3. Watters, David A., Michael J. Hollands, Russell L. Gruen, Kiki Maoate, Haydn Perndt, Robert J. McDougall, Wayne W. Morriss, Viliami Tangi, Kathleen M. Casey, and Kelly A. McQueen. 2015. “Perioperative Mortality Rate (POMR): A Global Indicator of Access to Safe Surgery and Anaesthesia.” World Journal of Surgery 39 (4): 856–64.
4. Weiser, Thomas G., Martin A. Makary, Alex B. Haynes, Gerald Dziekan, William R. Berry, Atul A. Gawande, and Safe Surgery Saves Lives Measurement and Study Groups. 2009. “Standardised Metrics for Global Surgical Surveillance.” The Lancet 374 (9695): 1113–17.
5. Weiser, Thomas G., Marcus E. Semel, Alan E. Simon, Stuart R. Lipsitz, Alex B. Haynes, Luke M. Funk, William R. Berry, and Atul A. Gawande. 2011. “In-Hospital Death Following Inpatient Surgical Procedures in the United States, 1996-2006.” World Journal of Surgery 35 (9): 1950–56.
6. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. 2013. Geneva: World Health Organization.
7. Sheetz, Kyle H., Justin B. Dimick, and Amir A. Ghaferi. 2016. “Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery.” Annals of Surgery 263 (4): 692–97.