Surgical Anastomosis, Bypass, or Graft–Related Mortality: Temporal Trends and Demographic Disparities in the United States, 1999–2024

Q: What are the key findings of this study?

Surgical anastomosis, bypass, or graft-related age-adjusted mortality declined from 2.744 to 0.713 per 100,000 between 1999 and 2024 (AAPC -5.61%, 95% CI -7.34% to -3.86%).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Later complications of surgical operation with anastomosis, bypass, or graft (ICD-10 code Y83.2) (n=87980). Intervention: Surgical operation involving anastomosis, bypass, or graft (ICD-10 code Y83.2) vs. Temporal comparison (1999 vs. 2024) and demographic/geographic subgroups. Primary outcome: Age-adjusted mortality rate (AAMR) per 100,000 population and Average Annual Percent Change (AAPC) (AAPC -5.61%, 95% CI -7.34% to -3.86%, p=<0.05).

Q: What does this research mean for the field?

Age-adjusted mortality associated with surgical anastomosis, bypass, or graft complications in the United States declined significantly from 2.744 to 0.713 per 100,000 between 1999 and 2024, despite an interruption by a temporary surge around 2016–2021. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate national temporal trends and demographic and geographic disparities in mortality related to complications from surgical anastomosis, bypass, or graft procedures in the United States.

Sarim Hassan Shahab; Syeda Malika Naqvi; Unsa Arif; Hadia Ghazala Masood; Muhammad Ahmed; Aoun Hassan; Nagarjuna Keshapogu; Mustafa Saad

doi:10.21203/rs.3.rs-10681781/v1

September 30, 2026Open Access

Surgical Anastomosis, Bypass, or Graft–Related Mortality: Temporal Trends and Demographic Disparities in the United States, 1999–2024

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Key result

Surgical bypass and graft-related mortality fell ~74% between 1999 and 2024.

AAPC -5.61%
95% CI -7.34% to -3.86%
P<0.05
n=87,980

Why the study?

National mortality patterns associated with later complications of surgical operations involving anastomosis, bypass, or graft have not been well described.

Key Points

To evaluate national temporal trends and demographic and geographic disparities in mortality related to complications from surgical anastomosis, bypass, or graft procedures in the United States.
Extracted death-certificate data for adults aged 25 years or older from the CDC WONDER database for 1999–2024 using ICD-10 code Y83.2.
Calculated age-adjusted mortality rates (AAMRs) per 100,000 population standardized to the 2000 U.S. population.
Estimated annual percent changes (APCs) and average annual percent changes (AAPCs) via joinpoint regression across sex, race and ethnicity, urbanization status, census region, and state.
Overall AAMR declined from 2.744 per 100,000 in 1999 to 0.872 in 2015 (APC, −7.56%; 95% CI, −8.38% to −6.72%), rose to 2.021 in 2020 (APC, 22.30%; 95% CI, 13.79% to 31.46%), and decreased to 0.713 in 2024 (APC, −25.80%; 95% CI, −31.25% to −19.92%), yielding an overall AAPC of −5.61% (95% CI, −7.34% to −3.86%).
Males had consistently higher AAMRs than females throughout the study period, while Non-Hispanic Black individuals had the smallest long-term decline (AAPC, −4.7116%) and the highest AAMR in 2024 (1.116 per 100,000).
Nonmetropolitan areas maintained higher AAMRs than metropolitan areas from 1999 to 2020, and Mississippi recorded the highest pooled state-level AAMR at 2.999 per 100,000.

Study Design

Type

Observational (n=87,980)

Multicenter

Yes

Structured PICO

P

Population

87,980 U.S. adult decedents aged ≥25 years with mortality attributed to later complications of surgical anastomosis, bypass, or graft (ICD-10 code Y83.2) from 1999 to 2024.

E

Exposure

Surgical operations involving anastomosis, bypass, or graft (identified via ICD-10 code Y83.2)

O

Outcome

Age-adjusted mortality rates (AAMRs) per 100,000 population standardized to the 2000 U.S. population, and temporal trends measured by Annual Percent Change (APC) and Average Annual Percent Change (AAPC) from 1999 to 2024hard clinical

Main Result

Effect estimate: AAPC -5.61% (95% CI -7.34% to -3.86%)

Absolute Event Rate: 0.713% vs 2.744%

p-value: p=<0.05

U.S. mortality attributed to complications of surgical anastomosis, bypass, or graft declined significantly overall from 1999 to 2024 (AAPC -5.61%), though interrupted by a sharp spike between 2015 and 2020 and marked by persistent disparities across sex, race, rurality, and geographic regions.

Limitations

Reliance on death certificates from the CDC WONDER database, which may involve coding errors and misclassification of cause of death
ICD-10 code Y83.2 groups all anastomosis, bypass, and graft procedures together without specifying exact surgical procedure, underlying disease, or complication type
Lack of detailed patient-level clinical data (e.g., comorbidities, operative urgency, surgical technique, hospital volume, or timing between surgery and death)
Observational ecological design precludes establishing causal links between temporal trends and specific improvements in surgical care
Potential influence of changing coding practices and healthcare utilization over time, particularly during the COVID-19 pandemic
Absence of data on postoperative morbidity or long-term functional outcomes among survivors
Reliance on death certificate data from the CDC WONDER database, which is subject to potential errors in death certification, coding, and misclassification of causes of death.
ICD-10 code Y83.2 groups all surgical operations involving anastomosis, bypass, or graft without specifying the exact surgical procedure, underlying disease, mechanism of death, or specific nature of the postoperative complication.
Lack of detailed patient-level clinical information such as comorbidities, operative urgency, surgical indication, technique, hospital characteristics, surgeon experience, and timing between surgery and death, precluding adjustment for confounders.
Observational ecological study design prevents establishing causal links between temporal trends and improvements in surgical care or healthcare policy.
Mortality patterns may have been influenced by changes in coding practices, reporting completeness, and healthcare utilization over time, particularly during the COVID-19 pandemic, and do not capture postoperative morbidity or functional outcomes among survivors.

Implication

Declining surgical complication mortality may reflect care advances; observational data leaves open drivers of disparities and the 2020 surge.

Abstract

Background Surgical operations involving anastomosis, bypass, or graft are performed across several specialties, but national mortality patterns associated with later complications of these procedures have not been well described. This study examined long-term trends and demographic and geographic differences in mortality recorded under International Classification of Diseases, Tenth Revision code Y83.2 in the United States. Methods Death-certificate data for adults aged 25 years or older were obtained from the CDC WONDER Multiple Cause of Death database for 1999–2024. Age-adjusted mortality rates (AAMRs) were calculated per 100,000 population and standardized to the 2000 U.S. population. Joinpoint regression was used to estimate annual percent changes (APCs) and average annual percent changes (AAPCs). Analyses were performed overall and by sex, race and ethnicity, census region, urbanization status, state, and place of death. Urbanization data were available through 2020. Results The annual overall extract included 87,980 deaths. The AAMR declined from 2.744 in 1999 to 0.872 in 2015 (APC, − 7.56%; 95% CI, − 8.38% to − 6.72%), increased to 2.021 in 2020 (APC, 22.30%; 95% CI, 13.79% to 31.46%), and then declined to 0.713 in 2024 (APC, − 25.80%; 95% CI, − 31.25% to − 19.92%). The overall AAPC was − 5.61% (95% CI, − 7.34% to − 3.86%). Males had higher AAMRs than females throughout the study period. Non-Hipanic (NH) Black individuals had the smallest long-term racial and ethnic decline and the highest AAMR in 2024. Nonmetropolitan areas had higher AAMRs than metropolitan areas during 1999–2020. The West experienced the steepest temporary regional increase, and Mississippi had the highest pooled state-level AAMR. Conclusion Mortality associated with surgical operations involving anastomosis, bypass, or graft declined significantly between 1999 and 2024, although the long-term improvement was interrupted by a marked increase beginning in the mid-to-late 2010s. Persistent differences across demographic and geographic groups indicate that the mortality burden was not distributed evenly.

Discussion

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Cite This Study

Shahab et al. (2026) conducted an observational in Later complications of surgical operation with anastomosis, bypass, or graft (ICD-10 code Y83.2) (n=87,980). Surgical operation involving anastomosis, bypass, or graft (ICD-10 code Y83.2) vs. Temporal comparison (1999 vs. 2024) and demographic/geographic subgroups was evaluated on Age-adjusted mortality rate (AAMR) per 100,000 population and Average Annual Percent Change (AAPC) (AAPC -5.61%, 95% CI -7.34% to -3.86%, p=<0.05). Surgical anastomosis, bypass, or graft-related age-adjusted mortality declined from 2.744 to 0.713 per 100,000 between 1999 and 2024 (AAPC -5.61%, 95% CI -7.34% to -3.86%).

synapsesocial.com/papers/6ae28f53cbadf70daf6c44e8 https://doi.org/10.21203/rs.3.rs-10681781/v1

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Surgical Anastomosis, Bypass, or Graft–Related Mortality: Temporal Trends and Demographic Disparities in the United States, 1999–2024

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Surgical Anastomosis, Bypass, or Graft–Related Mortality: Temporal Trends and Demographic Disparities in the United States, 1999–2024

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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