Key result
Hospitals with zero operative mortality over 3 years subsequently had similar or higher mortality than other hospitals (e.g., pancreatic resection 11.2% vs 8.7%; RR 1.29, 95% CI 1.04-1.59).
Why the study?
Does surgery at hospitals with a history of zero operative mortality reduce subsequent operative mortality compared to other hospitals?
Population
Medicare patients undergoing coronary artery bypass grafting, abdominal aortic aneurysm repair, or…
Comparison
Surgery at hospitals with zero operative… vs Surgery at all other hospitals
Design
Cohort
Follow-up
30-day or inpatient
Authors
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Zero-mortality history confers no subsequent benefit; challenges its reliability as a surgical quality metric.
Cohort
Yes
Does surgery at hospitals with a history of zero operative mortality reduce subsequent operative mortality compared to other hospitals?
Effect estimate: RR 1.09 (95% CI 0.92-1.29)
Absolute Event Rate: 6.3% vs 5.8%
Hospitals with a history of zero operative mortality do not have lower mortality in subsequent years, indicating that zero mortality is not a reliable indicator of future performance.
Dimick et al. (2007) conducted a cohort in High-risk surgery (CABG, AAA repair, colon, lung, and pancreatic cancer). Surgery at zero mortality hospitals (no inpatient or 30-day deaths during 1997-1999) vs. Surgery at all other hospitals was evaluated on Operative mortality in the subsequent year (2000) for abdominal aortic aneurysm repair (RR 1.09, 95% CI 0.92-1.29). Hospitals with zero operative mortality over 3 years subsequently had similar or higher mortality than other hospitals (e.g., pancreatic resection 11.2% vs 8.7%; RR 1.29, 95% CI 1.04-1.59).
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