Surgical problems very costly, report says

CHICAGO — Postoperative infections, surgical wounds accidentally opening and other often-preventable complications lead to more than 32,000 U.S. hospital deaths and more than $9 billion in extra costs annually, a report suggests.

Researchers from the U.S. government’s Agency for Healthcare Research analyzed data on 18 complications sometimes caused by medical errors. They found that such complications contribute to 2.4 million extra days in the hospital each year.

The findings greatly underestimate the problem, since many other complications happen that are not listed in hospital administrative data, the researchers said.

The study follows a 1999 Institute of Medicine report that said medical mistakes kill anywhere from 44,000 to 98,000 hospitalized Americans a year. That report focused national attention on the problem and led to numerous recommendations for improving safety.

The new report, based on data from 994 hospitals nationwide in 2000, provides a more detailed look at specific complications and the costs associated with each one.

Many of the 18 complications, including medical objects left inside patients after surgery, are preventable medical errors. Some, such as bleeding after surgery, might not always be avoidable, said Dr. Chunliu Zhan of the U.S. Agency for Healthcare Research and Quality. Zhan did the research with Dr. Marlene Miller, now at Johns Hopkins Children’s Center.

The study was published in today’s Journal of the American Medical Association.

"Given their staggering magnitude, these estimates are clearly sobering," Drs. Saul Weingart and Lisa Iezzoni of Harvard’s Beth Israel Deaconess Medical Center said in an accompanying editorial.

The most serious complication was post-surgery sepsis — bloodstream infections — which occurred in 2,592 patients. Sepsis resulted in an average of 11 extra days of hospitalization and $57,727 in extra costs per patient, plus a 22 percent higher risk of death.

Improved medical practices, including an emphasis on better hand-washing, might help reduce the rates, Zhan said.

Surgical wound openings were the second most serious complication, resulting in an average of nine extra days of hospitalization, $40,323 in extra costs and a nearly 10 percent higher death rate.