<div id="summaryView" role="tabpanel" aria-labelledby="tabSummaryView">
Name
Hospital Deaths Following Major Surgery
Short/Other Names

30-Day In-Hospital Mortality Following Major Surgery

Description

This indicator measures the rate of in-hospital deaths due to all causes occurring within 30 days of major surgery.

For further details, please see the General Methodology Notes.

Interpretation
A lower rate is more desirable.
HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility

Indicator Results

Accessing Indicator Results on Your Health System: In Depth

</div>
<div id="fullView" role="tabpanel" aria-labelledby="tabFullView">

<div role="button" class="expandableTitle" aria-controls="identifyingInfoRegion">Identifying Information</div>
Name
Hospital Deaths Following Major Surgery
Short/Other Names

30-Day In-Hospital Mortality Following Major Surgery


<div role="button" class="expandableTitle" aria-controls="descAndCalRegion">Indicator Description and Calculation</div>
Description

This indicator measures the rate of in-hospital deaths due to all causes occurring within 30 days of major surgery.

For further details, please see the General Methodology Notes.

Calculation: Description

The indicator is expressed as the rate of in-hospital deaths within 30 days of major surgery per 100 major surgical cases.

Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average

Unit of Analysis: Single admission

Calculation: Geographic Assignment

Place of service

Calculation: Type of Measurement

Rate - per 100

Calculation: Adjustment Applied

The following covariates are used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification document.

Calculation: Method of Adjustment

Logistic regression

Denominator

Description:
Acute hospitalizations with major surgery performed between April 1 and March 1 of the fiscal year
Inclusions:
1. Admission to an acute care institution (Facility Type Code = 1)

2. Major surgery (please refer to the General Methodology Notes document for the detailed list of major surgery Case Mix Groups [CMGs])

3. Procedure date for major surgery = April 1 to March 1

4. Age at admission 20 years and older

5. Sex recorded as male or female
Exclusions:
1. Records with missing/invalid major surgery date (CMG intervention date)

2. Records with invalid health card number

3. Records with an invalid code for province issuing health card number

4. Records with missing/invalid admission date

5. Records with missing/invalid discharge date

6. Cadaveric donor or stillbirth records (Admission Category Code = R or S)

Numerator

Description:
Cases within the denominator where an in-hospital death occurred within 30 days of major surgery
Inclusions:
1. Admission to an acute care institution (Facility Type Code = 1)

2. Discharge as death (Discharge Disposition Code = 07)

3. (Discharge [death] date) − (CMG intervention date) less than or equal to 30 days


<div role="button" class="expandableTitle" aria-controls="backgroundRegion">Background, Interpretation and Benchmarks</div>
Rationale

The volume of surgical procedures undertaken every year is considerably large. Complications in surgical care have become a major cause of death; as a result, surgical safety has been recognized as a significant public health concern and was one of the areas selected for the Global Patient Safety Challenges by the World Health Organization.

Studies have shown the importance of pre-operative assessment of patient conditions and risk, intra-operative surgical and anesthetic management and post-operative support in preventing surgical deaths. Although not all deaths are preventable, reporting on and comparing mortality rates for major surgical procedures may increase awareness of surgical safety and act as a signal for hospitals to investigate their processes of care before, during or immediately after the surgical procedure for quality improvement opportunities.

A 30-day follow-up time frame is commonly used for reporting hospital mortality, including mortality following major surgery. This allows for sufficient follow-up for complications from major surgery such as failure to wean, systemic sepsis, stroke and renal failure.

Interpretation

A lower rate is more desirable.

HSP Framework Dimension

Health System Outputs: Appropriate and effective

Areas of Need

Getting Better

Targets/Benchmarks

Not applicable

References

Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-144.

World Health Organization. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. http://whqlibdoc.who.int/publications/2009/9789241598552_eng.pdf. Updated 2009. Accessed July 26, 2010.

Goldhill DR. Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. Br J Anaesth. 2005;95(1):88-94.

Rossi M, Iemma D. Patients with comorbidities: what shall we do to improve the outcome. Minerva Anestesiol. 2009;75(5):325-327.

Person SD, Allison JJ, Kiefe CI, et al. Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Med Care. 2004;42(1):4-12.

Aiken LH, Clarke SP, Sloane DM, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-1993.

Englesbe MJ, Fan Z, Baser O, et al. Mortality in medicare patients undergoing surgery in July in teaching hospitals. Ann Surg. 2009;249(6):871-876.

American College of Surgeons National Quality Improvement Program. ACS NSQIP: Program Overview. Available at http://site.acsnsqip.org/wp-content/uploads/2012/11/NSQIP-Overview-10.12.pdf. Updated 2012. Accessed February 12, 2014.

Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005; 242(3), 326.


<div role="button" class="expandableTitle" aria-controls="availabilityRegion">Availability of Data Sources and Results</div>
Data Sources

DAD, HMDB

Available Data Years

Type of Year:
Fiscal
First Available Year:
2012
Last Available Year:
2016

Geographic Coverage

All provinces/territories

Reporting Level/Disaggregation

National, Province/Territory, Region, Facility


<div role="button" class="expandableTitle" aria-controls="resultRegion">Result Updates</div>
Update Frequency

Every year

Indicator Results

Web Tool:
Your Health System: In Depth
URL:
Accessing Indicator Results on Your Health System: In Depth

Updates

Not applicable


<div role="button" class="expandableTitle" aria-controls="qualityRegion">Quality Statement</div>
Caveats and Limitations

Not applicable

Trending Issues

Not applicable

Comments

Indicator results are also available in

–Your Health System: Insight
(https://www.cihi.ca/en/applications), updated monthly starting from 2012–2013

</div>