Key result
US surgical complication mortality averages ~5.3 per 100,000, peaking sharply between 2015 and 2021.
Why the study?
Long-term national mortality trends and demographic disparities associated with surgical complications remained poorly characterized at the population level.
Cohort (n=470,098)
Mortality associated with surgical complications in the US showed substantial temporal variation from 1999 to 2024, with persistent demographic and geographic disparities.
Temporal variation and disparities in surgical mortality rates may inform quality initiatives; observational data leaves open causal drivers and interventions.
Background: Complications of surgical operations remain an important contributor to preventable mortality, despite advances in perioperative care, anesthesia, and surgical safety. However, long-term national mortality trends and demographic disparities associated with surgical complications remain poorly characterized at the population level. Methods: We conducted a retrospective analysis of U.S. mortality data from the CDC WONDER Multiple Cause of Death database between 1999 and 2024. Deaths attributed to complications of surgical operations were identified using ICD-10 Y83 codes. Age-adjusted mortality rates (AAMRs) per 100 000 population were calculated using the 2000 U.S. standard population. Temporal trends were evaluated using Joinpoint regression analysis to estimate annual percentage changes (APCs) with 95% confidence intervals (CIs). Mortality patterns were stratified by sex, race/ethnicity, census region, urbanization status, and state. Results: A total of 470 098 deaths were attributed to complications of surgical operations during the study period. The overall AAMR was 5.3 (95% CI: 5.2–5.4). Mortality declined significantly from 8.1 in 1999 to 3.4 in 2015 (APC: −5.56, P < 0.000001), increased sharply to 7.9 in 2021 (APC: 16.20, P < 0.000001), and subsequently declined to 3.2 in 2024 (APC: −31.85, P < 0.000001). Men demonstrated consistently higher mortality than women (6.7 vs. 4.3 per 100 000). Non-Hispanic Black and American Indian/Alaska Native populations had the highest mortality rates, whereas Asian or Pacific Islander populations had the lowest. Mortality was higher in non-metropolitan areas and in several Southern and Midwestern states. Conclusion: Mortality associated with complications of surgical operations in the United States has demonstrated substantial temporal variation and persistent demographic and geographic disparities between 1999 and 2024. Further studies using patient-level clinical datasets are needed to clarify the underlying contributors to these patterns and identify potential targets for intervention.
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Sailish et al. (2026) conducted a cohort in Complications of surgical operations (n=470,098). Complications of surgical operations was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population (95% CI 5.2-5.4). Mortality attributed to surgical complications in the US showed an overall age-adjusted rate of 5.3 per 100,000 from 1999 to 2024, with a sharp increase between 2015 and 2021 followed by a steep decline.
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