Is crude postoperative mortality rate a relevant criterion of the efficiency of a surgical team? Prospective study of 11,756 patients' postoperative course

Aim. - Evaluation of the crude postoperative mortality rate as a relevant criterion of the efficiency of a surgical team. Materiel and methods: We studied prospectively the postoperative course of 11,756 consecutive patients who underwent a general surgery procedure between January 1(st) 1987 and December 31 2002. Results. - Seventy-three of patients died (0.60 percent). The median age at the time of death was 77 years old. None of the 5046 patients under 40 years old died. The operations were emergent in 3,265 patients (28 percent). The mortality rate of the 3,952 digestive surgery patients was 1.00 percent (40/3,952 patients). Among them, the mortality rate increased to 3.56 percent (17/478 patients) in case of an emergency procedure excluding procedures for non-suppurative appendicitis. Although only 8 percent of the patients were operated for a cancer (968/11,756 patients), they accounted for 49 percent of the postoperative deaths. In this cohort, the crude mortality rate varied by twice as much as were taken in account (73 deaths) or not (34 deaths) the palliative procedures in terminal phase patients, and the last-chance procedures in patients in imminent-death condition. Six hundred and twenty patients (5.3 percent) experienced at least one postoperative complication, surgical in 166 patients, and parietal in 258 patients. Conclusion. - This study shows that a long-term rigorous self-assessment is feasible. It confirms that the crude mortality rate is not a relevant criterion to evaluate the efficiency of a surgical team, suggests that an "avoided death" concept is more representative of medical team work and more rewarding for them and allows us to propose an index taking in account the rate of postoperative complications not followed by death. (c) 2005 Elsevier SAS. Tous droits reserves.