Complications of surgery

A patient advocate who blogs at 2centsdujour has come right out and asked the same question that’s been bothering me ever since the death of Andy Rooney last week: Unexpected and fatal complications from surgery? What happened?

The curmudgeonly CBS commentator must be wondering what happened too. Pat Mastors, who lost her own father to “complications of surgery” five years ago, channels Rooney’s unique brand of bemused crankiness to speculate about the whole situation:

“I died last week, just a month after I said goodbye to you all from this very desk. I had a long and happy life – well, as happy as a cranky old guy could ever be. 92. Not bad. But then I read what killed me: ‘serious complications following minor surgery’.

 “Now what the heck is that?

 “Nobody gets run over by a ‘serious complication’. You don’t hear about a guy getting shot in the chest with a ‘serious complication’. Sure, I didn’t expect to live forever (well, maybe only a little bit), but I was sorta going for passing out some Saturday night into my strip steak at that great restaurant on Broadway. Maybe nodding off in my favorite chair, settling into a good dream of reeling in a 40-pound striper. You know, not waking up. This whole ‘death by complication’ thing is just so, I don’t know…vague and annoying. It bothers me.”

Somewhat surprisingly, most news reports have glossed over the apparent sequence of events: 92-year-old patient undergoes what reportedly was a minor surgical procedure, unexpectedly develops serious complications and dies in the hospital.

No other information is available, so it’s impossible to know what actually happened. But it’s a blunt reminder of the risks patients face whenever they undergo surgery – even when the procedure is minor or routine.

There’s no accurate estimate for how many patients die in the U.S. from complications of surgery. The most widely quoted figure of health care-related fatalities comes from the now-famous Institute of Medicine report, “To Err Is Human,” but the number – 45,000 to 98,000 – is purely an estimate and includes all deaths related to medical error, not just those involving surgical complications. The best available statistic is that about one in six patients undergoing surgery will develop potentially life-threatening complications.

Surgery is risky, period. Complications can range from a bad anesthesia reaction to hospital-acquired infection or technical error by the surgeon. Many of these are considered preventable, and hospitals are under growing pressure to develop safer processes and lower the rate of complications and deaths.

Over the past decade, a considerable body of research has been built on how to reduce surgery-related complications. One intriguing study, published in 2009 in the New England Journal of Medicine, found that lowering the incidence of complications might be only half the picture. Hospitals also need to get better at managing complications when they do arise, the researchers concluded after examining outcomes among 84,000 patients at 186 U.S. hospitals. Other studies have demonstrated the benefit of checklists and protocols to prevent complications such as infection or post-surgery blood clots.

It’s not easy to tease apart the types of complications that are preventable from those that aren’t. The rate of fatal surgery-related complications undoubtedly could be lower than it is, however. Whether the patient is 9 or 90, death is not the outcome anyone would wish for, and it’s not an outcome that should be seen as acceptable.

Photo: Wikimedia Commons

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