Impact of procedure-related complications on patient outcome on a general medicine service

Impact of procedure-related complications on patient outcome on a general medicine service

To determine the importance of procedure-related complications on a general medical service. A retrospective cohort study with one-to-one matching. Complications were identified through chart review by nurse-technicians using standard definitions. The internal medicine service of a 900-bed universit...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM Vol. 9; no. 2; pp. 66 - 70
Main Authors: NETTLEMAN, M. D, BOCK, M. J, PETTINGER NELSON, A, FIESELMANN, J
Format: Journal Article
Language:English
Published: Heidelberg Springer 01-02-1994
Subjects:
Biological and medical sciences
Cause of Death
Cohort Studies
Economy. Management
Health and social institutions
Humans
Inpatients
Iowa - epidemiology
Medical sciences
Morbidity
Mortality
Pneumothorax - etiology
Public health. Hygiene
Public health. Hygiene-occupational medicine
Punctures - adverse effects
Retrospective Studies
Therapeutics - adverse effects
Iowa
Human
Costs
Treatment
Internal medicine
Health economy
Complication
Hospitalization
Public health
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Summary:To determine the importance of procedure-related complications on a general medical service. A retrospective cohort study with one-to-one matching. Complications were identified through chart review by nurse-technicians using standard definitions. The internal medicine service of a 900-bed university hospital. One hundred seven cases with noninfectious, procedure-related complications and 107 closely matched controls who underwent the same procedures without complication. None. The mortality rate was 28% for cases compared with 11% for controls, resulting in an excess mortality rate of 17% (p = 0.02). Cases who survived to discharge had an excess length of stay of seven days (p = 0.001). The excess cost per case was $12,913. Importantly, median reimbursement was only $2,064 higher for cases than for controls. Adjusting for age and APACHE II (severity of illness) score, procedure-related complications were associated with a 3.4-fold increase in the relative risk of in-hospital mortality (95% CI: 1.5 to 7.7). Surveillance data were useful in directing quality improvement activities that resulted in a 66% reduction in the rate of pneumothorax following thoracentesis. Procedure-related complications were associated with prolonged and expensive hospitalization and were a marker for patients at high risk for in-hospital mortality. Programs to reduce complications on the general medical service have an enormous potential to benefit both patients and hospitals.
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ISSN:0884-8734
1525-1497
DOI:10.1007/BF02600202