Presentation Details
| Inpatient Perioperative Complications: A Multi-Center, Million Patient Analysis Joshua Bloomstone1, 2, 3, 5, Bruce Kingsley1, 3, Benjamin Houseman1, 3, 5, Tania Haddad3, Sarah Sigler3, Boyoung Garlapati6. 1University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.2University College London, London, United Kingdom.3Envision Healthcare, Nashville, TN, USA.4Outcomes Research Consortium, Houston, TX, USA.5Memorial Hospital System, Hollywood, FL, USA.6Amazon.com, Seattle, WA, USA |
Abstract
BACKGROUND: Over 48 million inpatients will undergo surgery in the US per year. Of these, 5% to 45% will suffer post-surgical complications. In 2019 we built a tool to quantify our group's contribution to this surgical burden, which offers a more accurate picture of perioperative morbidity and its contributors.
PURPOSE: This innovative tool both retrospectively and prospectively gathered data from 35-centers on 1,214,000 patients who underwent inpatient surgical care between 10/1/2017 and 12/12/2023. CPT and ICD-10 coding was used to automatically define procedure and complication types. Age, sex, and day upon which a complication were reported. This work received a D4 IRB exemption.
RESULTS: Proportion of Complications by Surgical Service line: Cardiac Surgery: 23.72%, ECMO: 20:31%, Neurosurgery: 19.89%, Thoracic Surgery: 19.08%. Most Frequent Major Complications within 7 days of surgery per 1000 patients: Post-operative pulmonary complications: 6.41, Acute Kidney Injury: 5.36, Post surgical sepsis: 4.64, Acute Coronary Syndrome: 1.00, Stroke and new neurologic deficit: 0.69, Cardiac Arrest: 0.63 Proportion of Complications by age: 0-10 0.67%, 11-20 2.48%, 21-30 3.63%, 31-40 4.95%, 41-50 7.43%, 51-60 8.83% , 61-70 8.51%, 71-80 8.65%, 81-90 11.81%, 91-100 15.65%. Overall complications rates have decreased since 2017. (Other data shown in poster- Morbidity vs ASA PS, COVID Status)
CONCLUSIONS: Our study confirms that complications following major inpatient surgery occur in up to, and sometimes exceed 1:4 patients. Post-operative pulmonary & renal complications, and post-surgical sepsis occur more frequently than cardiac or neurologic events, and increase with age and male sex. Post-pandemic surgical complication rates have slowly declined and are now below pre-pandemic rates. Overall complication rates have decreased since 2018 (ERAS effects ?). MINS was not accounted for given the lack of a specific ICD-10 code.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
PURPOSE: This innovative tool both retrospectively and prospectively gathered data from 35-centers on 1,214,000 patients who underwent inpatient surgical care between 10/1/2017 and 12/12/2023. CPT and ICD-10 coding was used to automatically define procedure and complication types. Age, sex, and day upon which a complication were reported. This work received a D4 IRB exemption.
RESULTS: Proportion of Complications by Surgical Service line: Cardiac Surgery: 23.72%, ECMO: 20:31%, Neurosurgery: 19.89%, Thoracic Surgery: 19.08%. Most Frequent Major Complications within 7 days of surgery per 1000 patients: Post-operative pulmonary complications: 6.41, Acute Kidney Injury: 5.36, Post surgical sepsis: 4.64, Acute Coronary Syndrome: 1.00, Stroke and new neurologic deficit: 0.69, Cardiac Arrest: 0.63 Proportion of Complications by age: 0-10 0.67%, 11-20 2.48%, 21-30 3.63%, 31-40 4.95%, 41-50 7.43%, 51-60 8.83% , 61-70 8.51%, 71-80 8.65%, 81-90 11.81%, 91-100 15.65%. Overall complications rates have decreased since 2017. (Other data shown in poster- Morbidity vs ASA PS, COVID Status)
CONCLUSIONS: Our study confirms that complications following major inpatient surgery occur in up to, and sometimes exceed 1:4 patients. Post-operative pulmonary & renal complications, and post-surgical sepsis occur more frequently than cardiac or neurologic events, and increase with age and male sex. Post-pandemic surgical complication rates have slowly declined and are now below pre-pandemic rates. Overall complication rates have decreased since 2018 (ERAS effects ?). MINS was not accounted for given the lack of a specific ICD-10 code.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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