Report: Sicker surgical patients fared better post-pandemic

Editor's Note

Hospitals achieved a substantial reduction in mortality risk for surgical inpatients between 2019 and 2024, even as patients grew sicker and stayed longer, according to a report released August 5 by the American Hospital Association (AHA) and Vizient.

In the first quarter of 2024, hospitalized surgical patients were nearly 20% more likely to survive than expected, compared to baseline data from the fourth quarter of 2019, the data show. Additionally, the risk-adjusted mortality rate for surgical inpatients dropped from 0.97 in late 2019 to 0.79 in early 2024, based on Vizient’s risk adjustment methodology. This improvement coincided with better hospital performance on safety metrics, including lower rates of post-operative hemorrhage (down 22.3%), sepsis (down 9.2%), and respiratory failure (down 19.0%).

The report also highlights continued declines in complications such as vascular catheter-associated infections (down 9.2%), catheter-associated urinary tract infections (down 6.6%), and patient falls (down 10.7%), which are known contributors to increased length of stay and mortality. These safety improvements occurred alongside a broader trend of shifting lower-acuity surgeries to outpatient settings, leaving hospitals to care for a higher concentration of complex and high-acuity surgical patients.

As acuity increased, so did average hospital length of stay, which has risen by nearly one day over the past five years. The AHA and Vizient attribute this to both rising clinical complexity and delays in post-acute care access. Among Medicare Advantage patients, the average stay prior to discharge to post-acute care is now twice as long as for Traditional Medicare beneficiaries.

Looking ahead, Vizient projects continued growth in surgical acuity. By 2035, quaternary surgical cases—representing the sickest patients—are expected to drive a 19% increase in total hospital days, with tertiary surgical patients contributing a 16% rise. In contrast, low-acuity inpatient days are projected to grow just 7%.

More details are available in the full report, which is based on analyses of 18 quarters of data from a cohort of 713 general acute care hospitals in the Vizient Clinical Data Base, representing over 1,300 hospitals nationwide.