Hospital surgery patients are sicker, but they're seeing better outcomes

Patients having surgery in hospitals are faring better than they did several years ago.

Chris DeRienzo, MD, chief physician executive of the American Hospital Association, says a new report from the AHA and Vizient outlines important gains in treating surgical patients in hospitals.

Surgical patients in hospitals were more likely to survive in 2024 than in 2019, according to a new report released Tuesday by the American Hospital Association and Vizient. The report finds surgical patients in hospitals are now having better outcomes than pre-pandemic patients.

In fact, surgical patients in hospitals in the first quarter of 2024 were nearly 20% more likely to survive than expected, based on their conditions, compared to patients in the fourth quarter of 2019.

Hospital patients were also less likely to experience post-surgical complications over that five-year span. Patients also experienced fewer infections and falls in the hospital.

Hospitals are treating patients with more complex conditions, the report finds.

With more patients choosing outpatient or ambulatory surgery centers for their procedures, the patients having surgeries in hospitals typically are facing more serious illnesses or injuries.

Chris DeRienzo, MD, chief physician executive of the American Hospital Association, tells Chief Healthcare Executive® that the report underscores important gains in care for surgical patients that show progress even compared to pre-pandemic levels.

“Our data shows that patients who are hospitalized in the first quarter of 2024 were materially safer across numerous outcomes relative to 2019,” DeRienzo says. “So those gains drove through the pandemic despite all of the external forces acting on hospitals and communities and the people who work within them.”

Fewer complications

Hospitals reduced three post-operative complications that can be especially harmful to patients between 2024 and 2019. Hospitals saw a decline in post-operative hemorrhage (a drop of 22.6%), respiratory failure (a decline of 18.9%) and sepsis (a 9.2% decline).

The decline in those complications helps explain the reduction in mortality in surgical patients, DeRienzo says.

“We know surgeries are among the highest acuity events that happen within the four walls of the hospital,” he says. “So these are three significant events that can occur in the course of a surgical patient's hospitalization … post-operative bleeding, post-operative infection and post-operative respiratory failure. All three of those are linked to a rising risk of morbidity and mortality if they're experienced by a patient, and we showed in this report that all three of those are substantially down.”

With hospitals seeing surgical patients with more complex conditions, the average length of stay for those surgical patients has increased by nearly one full day over the past five years.

“The surgical patients who we care for in hospitals are getting sicker and sicker and sicker and sicker, and that trend is forecast to continue over the coming decade,” DeRienzo says.

Discharge delays

Some of the increase in the length of stay is tied to the higher acuity of the patients, but it’s also tied to more insurers delaying discharges from the hospital and hurdles in getting approval for patients to go to post-acute care facilities, the report found.

“We certainly have some concerns that patients are certainly of higher acuity, but in many instances, perhaps staying in the hospital longer than they need to, and that is not related to their actual clinical conditions,” DeRienzo adds.

Hospitals have been increasingly frustrated with insurers, including Medicare Advantage plans, for delays in discharges to post-acute facilities. A hospital association report released in February found Medicare Advantage patients in rural hospitals are staying in hospitals longer than patients using traditional Medicare.

Hospitals have struggled to get placements to nursing homes, rehabilitation centers and other post-acute facilities in recent years.

“It’s not going away,” DeRienzo says. “And certainly I worry about it getting worse, because the higher acuity of a patient you are, the more likely you're going to need some kind of post-acute care that is not able to be provided in your home.”“What that leads to is all of the challenges that are then faced back in the hospital environment, where we have more patients who need our services and their access to securing that care gets challenged,” he adds.

Concerns about access

Other studies have found hospitals making improvements in patient safety. The Leapfrog Group, an organization focused on patient safety, released its latest round of hospital grades in the spring and found hospitals had made progress in reducing infections.

Katie Stewart, The Leapfrog Group’s director of health care ratings, told Chief Healthcare Executive® in the spring that hospitals are making “really dramatic improvements.”

The new hospital association report follows another study released last September by the AHA and Vizient which found patient safety metrics have improved even compared to pre-pandemic levels.

While encouraged by the progress hospitals are making in treating surgical patients, DeRienzo says he’s concerned that pending Medicaid cuts in the tax package could stall those gains.

The tax package is projected to reduce Medicaid funding by nearly $1 trillion over the next decade, and hospitals say funding cuts could lead to some facilities cutting services, reducing staff and possibly shutting down. Nearly 12 million Americans are projected to lose Medicaid coverage.

“I do worry about access to care for patients who are going to be impacted by these shifts in coverage,” DeRienzo says. “And invariably, our hospitals are both pillars of and reflections of their communities. And so when we see the kinds of impacts to access to care, events that are forecast in terms of the rising number of uninsured patients, I worry about our communities.”