Is 30-day mortality a good surgery quality metric for elderly patients?

Although 30-day mortality rates are traditionally used as a measure for surgical quality, the metric may not be applicable when dealing with elderly patients, according to a recent report from The New York Times.

Several states require public reporting of 30-day mortality rates after cardiac procedures and Medicare has begun measuring 30-day mortality after pneumonia and heart attacks as a basis for hospital penalties and rewards.

Despite the shift toward using the metric for quality reporting, some physicians and healthcare experts have become increasingly wary of the standard, according to the report.

Critics say 30-day mortality measures can cause unintended harm by discouraging surgery for high-risk patients even though they could benefit from it and delaying important conversations about palliative care or hospice in elderly patients.

Lisa Lehmann, MD, PhD, an associate professor of medical ethics at Harvard Medical School, told The New York Times that 30-day mortality statistics create a conflict of interest. "It can lead to the violation of a physician's duty to put patients' interests first," she said.

According to the report, critics of the measure suggest changing the benchmark to 60 or 90 days or tracking patients having palliative surgery to relieve symptoms separately since their goal is comfort, not survival.

Gretchen Schwarze, MD, a vascular surgeon at the University of Wisconsin-Madison, called the 30-days a "game-able number" and suggests including days spent in the intensive care unit or on a ventilator in quality measures.

"Medicine isn't just about keeping people alive," Dr. Schwarze told The New York Times. "Some of it is about relieving suffering. Some of it is about helping people die."



More articles on surgery safety:
Surgeons to use online exchange to share data on hernia treatment
10 ways hospitals are making surgeries safer
University of Iowa Hospitals and Clinics uses analytics to predict post-surgical infections

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