"Identifying Information: Name","Hospital Deaths Following Major Surgery"
"Identifying Information: Short/Other Names","30-Day In-Hospital Mortality Following Major Surgery"
"Identifying Information: 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)."
"Background, Interpretation and Benchmarks: 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 ºìÁì½í¹Ï±¨ 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."
"Background, Interpretation and Benchmarks: Interpretation","A lower rate is more desirable."
"Background, Interpretation and Benchmarks: HSP Framework Dimension","Appropriate and effective"
"Background, Interpretation and Benchmarks: Areas of Need","Getting Better"
"Background, Interpretation and Benchmarks: Targets/Benchmarks","Not applicable"
"Available Data Years","2019
 to 2023"
"Available Data Years: Type of Year",Fiscal
"Availability of Results: Geographic Coverage","All provinces/territories"
"Reporting Level/Disaggregation",National
"Result Updates: Indicator Results","Web Tool:Your ºìÁì½í¹Ï±¨ System: In DepthPDF:Accessing Indicator Results on Your ºìÁì½í¹Ï±¨ System: In Depth (PDF)"
"Update Frequency","Every year"
"Result Updates: Latest Results Update Date","December 2024"
"Result Updates: Updates","Not applicable"
"Indicator Calculation: 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 averageUnit of Analysis: Single admission"
"Indicator Calculation: Type of Measurement",Rate
"Indicator Calculation: Number or Rate","per 100"
"Denominator: Description:","Acute hospitalizations with major surgery performed between April 1 and March 1 of the fiscal year"
"Denominator: 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 1Age at admission 18 years and olderSex recorded as male or female"
"Denominator: Exclusions:","Records with missing/invalid major surgery date (CMG intervention date)Records with invalid health card numberRecords with an invalid code for province issuing health card numberRecords with missing/invalid admission dateRecords with missing/invalid discharge dateCadaveric 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"
"Numerator: 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 daysNote*2018–2019 data onward"
"Numerator: 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."
"Indicator Calculation: Geographic Assignment","Place of service"
"Data Sources",DAD
"Quality Statement: Caveats and Limitations","Not applicable"
"Quality Statement: Trending Issues","Not applicable"
"Quality Statement: Comments","Indicator results are also available inYour ºìÁì½í¹Ï±¨ System: Insight, updated monthly"
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 ºìÁì½í¹Ï±¨ 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."