Is it Time to Abandon 30-Day Mortality as a Quality Measure?

Excerpt

Thirty-day operative mortality is one of the primary outcome measures used to assess and communicate risk, evaluate surgical safety, compare hospital quality, and provide a benchmark in public reporting and pay-for-performance initiatives. Fortunately, improvements in perioperative care have been largely successful at minimizing early treatment-related postoperative deaths. However, as perioperative care continues to advance with more life-sustaining therapies than historically available, many deaths occur beyond 30 days. Therefore, quality assessments based on 30-day events may actually underestimate the true risk. As such, there is a growing sentiment that 30-day mortality alone may not be the most appropriate measure of operative risk or surgical quality of care. Underestimating postoperative mortality can have major implications, such as shifting the risk profile towards favoring surgery in situations where there are alternative options and providing patients with inaccurate expectations regarding their operative risk. Thus, although there are many considerations and potential unintended consequences, there is increasing interest by the surgical community to extend the postoperative mortality timeframe from 30 to 90 days. …