Improving Survival Rates for Surgical Patients: 3 Takeaways

Despite treating sicker and more clinically complex patients, hospitals have made significant gains over the past five years in improving survival rates for surgical patients and reducing post-surgical complications, according to a recent report from the AHA and Vizient.

The detailed analysis found a 22% reduction in mortality risk for hospitalized surgical patients in the first quarter of 2024 compared with Q4 results in 2019.

The significant improvement aligned not only with better performance on patient safety metrics such as reductions in infections and falls, but also with marked declines in three high-risk complications strongly linked to mortality:

• Post-operative hemorrhage.
• Post-operative sepsis.
• Post-operative respiratory failure.

Safety Improvements Saved Lives

Also worth noting, the improvements came during a time when patients were presenting with more complex conditions, the report notes.

The new findings build on a report the AHA released in collaboration with Vizient last year showing that hospitals and health systems performed better on key patient safety and quality measures in the first quarter of 2024 than they did before the COVID-19 pandemic. In fact, hospitals’ efforts to improve safety led to 200,000 Americans being hospitalized between April 2023 and March 2024 and surviving episodes of care that they wouldn’t have in 2019.

“The safety and quality improvements in surgical outcomes underscore the resilience and unwavering commitment of hospitals and health systems — and the millions of hospital team members across the country — to delivering better care to the patients and communities they serve,” said AHA President and CEO Rick Pollack. “While hospitals are proud of these efforts, we know there is always more work to do to deliver the highest quality care possible.”

3 Meaningful Takeaways

1 | Post-operative complications were down.

Declines were found in three high-risk areas: post-operative bleeding (down 22.3%); sepsis (down 9.2%) and respiratory failure (down 19.0%). Together, these reductions in patient safety indicators linked to mortality among hospitalized surgery patients represent a key factor in contributing to overall improvement in survival rates.

Takeaway

Infections and falls significantly can increase the risk of complications, prolong hospital stays and elevate the likelihood of mortality. As previously demonstrated in two recent AHA Insights Reports, as of Q1 last year, hospitalized surgical patients are experiencing vascular catheter-associated (down 9.2%), catheter-associated urinary tract infections (down 6.6%) and falls (down 10.7%) at lower levels than those recorded in 2019. These improvements likely are contributing to the reduction of risk in mortality noted for hospitalized surgical patients, the report states.

2 | Patient acuity rose.

As an increasing number of surgical procedures shifted to outpatient or ambulatory settings, the surgical patients who remained hospitalized tended to present with greater clinical complexity and required higher acuity care, the analysis showed.

Takeaway

Vizient projects that this trend will continue to intensify over the next decade. Despite comprising just 2% of 2025 hospital days, those who need the most intensive care, often called “quaternary” patients, will drive the most days of growth. By 2035, quaternary days are expected to grow 19%. Most of these sick patients will be in the hospital for surgery. Tertiary patient days — those with slightly lower care needs than quaternary patients by more than twice the complexity of lower acuity patients — are projected to grow by 16% by 2035. Meanwhile, lower-acuity patient days are expected to grow a modest 7% over the next decade.

3 | Length of stay increased.

The average length of stay for hospitalized surgical patients increased by nearly a full day over the past five years, the report states.

Takeaway

This rise correlates with both increasing patient acuity and a growing trend among insurers to delay discharges and deny coverage for appropriate post-acute care services. The data also complement AHA analyses showing that tactics used by commercial insurers — particularly Medicare Advantage plans — are leading to the delayed discharges and denials of appropriate post-hospital care.

Download the full AHA-Vizient report.