Hospital Deaths Following Major Surgery
A lower rate is more desirable.
The indicator is expressed as the rate of in-hospital deaths within 30 days of major surgery per 100 major surgical cases.
Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average
Unit of Analysis: Single admission
Acute hospitalizations with major surgery performed between April 1 and March 1 of the fiscal year
Cases within the denominator where an in-hospital death occurred within 30 days of major surgery
Methodology
Name
Hospital Deaths Following Major Surgery
Short/Other Names
30-Day In-Hospital Mortality Following Major Surgery
Description
This indicator measures the rate of in-hospital deaths due to all causes occurring within 30 days of major surgery.
For further details, please see the General Methodology Notes (PDF).
Rationale
The volume of surgical procedures undertaken every year is considerably large. Complications in surgical care have become a major cause of death; as a result, surgical safety has been recognized as a significant public health concern and was one of the areas selected for the Global Patient Safety Challenges by the World Health Organization.
Studies have shown the importance of pre-operative assessment of patient conditions and risk, intra-operative surgical and anesthetic management and post-operative support in preventing surgical deaths. Although not all deaths are preventable, reporting on and comparing mortality rates for major surgical procedures may increase awareness of surgical safety and act as a signal for hospitals to investigate their processes of care before, during or immediately after the surgical procedure for quality improvement opportunities.
A 30-day follow-up time frame is commonly used for reporting hospital mortality, including mortality following major surgery. This allows for sufficient follow-up for complications from major surgery such as failure to wean, systemic sepsis, stroke and renal failure.
Interpretation
A lower rate is more desirable.
HSP Framework Dimension
Health system outputs: Appropriate and effective
Areas of Need
Getting Better
Targets/Benchmarks
Not applicable
Available Data Years
to (fiscal years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
- Region
- Facility
Indicator Results
Update Frequency
Every year
Latest Results Update Date
Updates
Not applicable
Description
The indicator is expressed as the rate of in-hospital deaths within 30 days of major surgery per 100 major surgical cases.
Risk-adjusted rate = Observed cases ÷ Expected cases × Canadian average
Unit of Analysis: Single admission
Type of Measurement
Rate - per 100
Denominator
Description:
Acute hospitalizations with major surgery performed between April 1 and March 1 of the fiscal year
Inclusions:
- Admission to an acute care institution (Facility Type Code = 1)
- Major surgery (please refer to the General Methodology Notes (PDF) document for the detailed list of major surgery Case Mix Groups [CMGs])
- Procedure date for major surgery = April 1 to March 1
- Age at admission 18 years and older
- Sex recorded as male or female
Exclusions:
- Records with missing/invalid major surgery date (CMG intervention date)
- Records with invalid health card number
- Records with an invalid code for province issuing health card number
- Records with missing/invalid admission date
- Records with missing/invalid discharge date
- Cadaveric donor or stillbirth records (Admission Category Code = R or S)
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)
Numerator
Description:
Cases within the denominator where an in-hospital death occurred within 30 days of major surgery
Inclusions:
- Admission to an acute care institution (Facility Type Code = 1)
- Discharge as death (Discharge Disposition Code = 07, 72*, 74*)
- (Discharge [death] date) − (CMG intervention date) less than or equal to 30 days
Note
*2018–2019 data onward
Exclusions:
- 2018–2019 data onward: Medical assistance in dying (MAID) (Discharge Disposition Code = 73)
Method of Adjustment
Logistic regression
Adjustment Applied
Covariates used in risk adjustment:
For a detailed list of covariates used in the model, please refer to the Model Specification (PDF) document.
Geographic Assignment
Place of service
Data Sources
- DAD
- HMDB
Caveats and Limitations
Not applicable
Trending Issues
Not applicable
References
Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139-144.
World Health Organization. WHO Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. https://iris.who.int/bitstream/handle/10665/44185/9789241598552_eng.pdf. Updated 2009. Accessed September 20, 2024.
Goldhill DR. Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. Br J Anaesth. 2005;95(1):88-94.
Rossi M, Iemma D. Patients with comorbidities: what shall we do to improve the outcome. Minerva Anestesiol. 2009;75(5):325-327.
Person SD, Allison JJ, Kiefe CI, et al. Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Med Care. 2004;42(1):4-12.
Aiken LH, Clarke SP, Sloane DM, et al. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-1993.
Englesbe MJ, Fan Z, Baser O, et al. Mortality in medicare patients undergoing surgery in July in teaching hospitals. Ann Surg. 2009;249(6):871-876.
American College of Surgeons National Quality Improvement Program. ACS NSQIP: Program Overview. Available at http://site.acsnsqip.org/wp-content/uploads/2012/11/NSQIP-Overview-10.12.pdf. Updated 2012. Accessed August 23, 2024.
Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005; 242(3), 326.
How to cite:
Canadian Institute for Health Information. Hospital Deaths Following Major Surgery . Accessed April 24, 2025.
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Comments
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