Seven Surgeries Account for 80 Percent of Deaths

Recent research published by JAMA Surgery reveals that an astonishing 80 percent of all hospital deaths and complications are a result of just seven emergency medical procedures. The study, which was led by the director of Emergency Surgery Services at Brigham & Women’s Hospital Dr. Joaquim M. Havens, included an analysis of more than 420,000 adults who underwent an emergency medical procedure within two days of being admitted to the hospital between 2008 and 2011. Heart-related procedures and emergency surgeries that were a result of motor vehicle crashes and other traumatic events were not included in the study.

Each year, more than three million individuals undergo emergency surgery in the United States. According to Havens, emergency general surgical procedures are often more risky than surgeries that are planned in advance. In fact, those who undergo elective surgeries are eight times more likely to survive without serious complications that those who experience the exact same type of procedure in an emergency. It is believed that this is partially due to the fact that individuals who undergo emergency surgery are typically in an urgent health crisis like gastrointestinal bleeding, severe infections, or obstruction of the bowel.

Disturbingly, the overall mortality rate for individuals who undergo emergency surgery is 1.23 percent, while the complication rate is an astonishing 15 percent. The average cost for each admission to the hospital was more than $13,000.

Which Emergency Procedures Are Most Risky?

While some of the surgical procedures that top the list are simply risky surgeries to begin with, the fact that they are performed in an emergency setting without the benefit of proper preparation makes them even more dangerous. According to the research, the seven emergency medical procedures that cause 80 percent of hospital deaths and complications include:

• Partial Colectomy: The emergency medical procedure that was determined to account for the highest burden is partial colectomy. While this procedure is not the most commonly performed on the list, when performed in an emergency situation the complication rate and mortality rate is very high. In fact, the complication rate for individuals who undergo a partial colectomy is a disturbing 42.8 percent, and the mortality rate is 5.33 percent.
• Small Bowel Resection: 46.94 percent of small bowel resections result in at least one complication, and 6.47 percent result in death. According to Dr. Havens, part of the reason for such a high ranking is that individuals who undergo this type of procedure are typically very ill and the lack of time to prepare makes the potential for infection high.
• Cholecystectomy: While the complication rate for cholecystectomy (gall bladder removal surgery) is only 8.06 percent, and the mortality rate is just 0.22 percent, this emergency procedure made the list due to the high number of surgeries that are performed.
• Surgical Management of Peptic Ulcer Disease: Ulcers that occur in the lining of the stomach often result in pain and bleeding that requires emergency surgical intervention. Although proton pump inhibitors have made this type of surgery much less common, the operation is usually performed on patients who are resistant to other procedures which makes it more complicated. The mortality rate is a disturbing 6.83 percent, and the rate of complications is 42 percent.
• Removal of Peritoneal Adhesions: Abdominal adhesions that are not treated can cause patients to become extremely ill. The complications that peritoneal adhesions cause make emergency surgery very risky. The complication rate for this type of procedure is 28.09 percent, and the mortality rate is 1.59 percent.
• Appendectomy: With a complication rate of just 7.27 percent and a death rate of only 0.08 percent, appendectomy is a fairly safe procedure. The frequency of the procedure, however, places this type of surgery on the list. During the four year period studied, more than 680,000 appendectomies were performed in the United States.
• Laparotomy: A death rate of 23.76 percent and a complication rate of 40.15 percent make a laparotomy sound extremely risky. The procedure is not frequently performed, but its high complication and mortality rates put it on the list. While the operation itself is not particularly risky, patients who undergo this type of procedure are often suffering from cancer or another condition that cannot be repaired.

The study reveals that an estimated 50 percent of individuals who undergo an emergency surgery will develop some type of complication, and 15 percent are re-admitted into the hospital within just 30 days. Since the research did not focus on individuals who had these and other procedures more than two days after hospital admission, possible differences in care and the full impact of these types of surgeries are not accounted for. Researchers suggest that a deeper analysis of these types of surgeries should be conducted to help identify the reasons they are so burdensome and to improve patient outcomes.