TY  - JOUR
T1  - Complication-associated mortality following trauma: A population-based observational study
AU  - Osler T, Glance LG, Hosmer DW
Y1  - 2012/02/01
N1  - 10.1001/archsurg.2011.888
JO  - Archives of Surgery
SP  - 152
EP  - 158
VL  - 147
IS  - 2
N2  - Context 
                  Complications are common in the care of trauma patients and contribute to morbidity, mortality, and cost. However, no comprehensive list of surgical complications is widely accepted.Objectives 
                  To create an empirical list of complications based on the International Classification of Diseases, Ninth Revision (ICD-9) lexicon and estimate the contribution of these complications to mortality.Design 
                  Retrospective database analysis.Setting 
                  Office of Statewide Health Planning and Development data set.Patients 
                  The Office of Statewide Health Planning and Development provided information on 409 393 patients admitted to 1 of 159 California hospitals between 2004 and 2008. We defined a complication to be any ICD-9– coded condition that accrued after hospital admission and significantly increased mortality.Main Outcome Measures 
                  Odds of mortality for individual complications and number of excess deaths due to individual complications based on attributable risk fractions.Results 
                  Eighty-two different ICD-9 codes contributed significantly to mortality as complications. Odds ratios ranged from 1.02 (hyperosmolarity) to 46.1 (ventricular fibrillation). There were a total of 175 299 complications (range, 0-14; average 0.4/patient). Twenty-four percent of patients had at least 1 complication. Mortality increased with the number of complications; each additional complication increased mortality by 8%. Absent any complications, there would have been 7292 fewer deaths, a 64% reduction in overall mortality.Conclusions 
                  Most complication-related mortality is due to 25 individual complications. Eliminating all complications might prevent two-thirds of deaths, but because many complications are not preventable, this figure is the upper bound on possible mortality reduction. Hospitals vary in their proportions of deaths due to complications, and thus, efforts to prevent complications might improve survival at some hospitals.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2011.888
UR  - http://dx.doi.org/10.1001/archsurg.2011.888
ER  -