Changes of the system of postoperative care decreases mortality in a surgical unit

Introduction

In 2005, 10 public health care institutions functioned in the area of Lodz, having in their structure a surgical unit classified as a general surgery unit. They were three university teaching hospitals, three provincial hospitals, three county hospitals and one departmental hospital. Mortality in university teaching hospitals having 167 beds was 1.25%, in provincial hospitals with 191 beds was 2.96%, and in county hospitals with 140 beds was 3.98%. The lowest percentage mortality was noted in the surgical unit of Bolesùaw Szarecki University Teaching Hospital No. 5 in Lodz (UH No. 5) and it was 0.35%. The authors decided to analyse the causes of such low mortality in this hospital. Two remaining university teaching hospitals, N. Barlicki University Teaching Hospital No. 1 in Lodz (UH No. 1) and WAM University Teaching Hospital No. 2 in Lodz (UH No. 2), were selected for comparative analysis. The selection was dictated by a few reasons. The Medical University in Lodz is the founding body of all hospitals subjected to analysis. These hospitals are only a few kilometres away from each other. The units have a similar number of beds, and well-educated medical and nursing staff. Heads of the hospital departments have all been awarded a professorship. Health benefits are provided on the basis of the same list of benefits as part of contract with the same payer – Lodz Provincial Branch of the National Health Fund.

Methods

The study is a retrospective analysis of mortality in general surgery units located at three university teaching hospitals: UH No. 1, UH No. 2 and UH No. 5. The study comprised 25,921 patients treated in these units from 1 January 2003 to 30 June 2006. The available statistical material was analysed. In the first stage the statistical data were analysed by the Provincial Centre of Public Health in Lodz. The obtained information concerned the number of treated patients, the number of patients transferred, discharged or dead, the number of man-days, mean bed use, mean hospitalisation time, mean number of patients per bed and mortality. The second stage focused on explaining the reasons for significantly lower mortality among patients hospitalised in the surgical unit of UH No. 5. Among others, the structure of the hospitalised patients in each of these units was analysed, the quantity and range of a contract signed with the unit financing the benefits and internal principles of these units functioning.

Results

Mortality in the general surgery unit of UH No. 5 was 0.40% within the period from 1 January 2003 to 30 June 2006. In the general surgery unit of UH No. 1 and of UH No. 2, mortality was respectively 2.70% and 2.13%.

Conclusion

Changes of the system of postoperative care consisting of taking over postoperative care by physicians and anaesthesiological nurses, intensive monitoring of postoperative patients, and immediate transfer of patients with life hazard to the ICU decreases significantly the mortality in a surgical unit.