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Annals of Family Medicine 4:410-416 (2006)
© 2006 Annals of Family Medicine, Inc.
doi: 10.1370/afm.553
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Excess Mortality Caused by Medical Injury

Linda N. Meurer, MD, MPH1,2, Hongyan Yang, MS1, Clare E. Guse, MS1,2, Carla Russo, MD1, Karen J. Brasel, MD, MPH2,3 and Peter M. Layde, MD, MSc1,2

1 Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisc
2 Injury Research Center, Medical College of Wisconsin, Milwaukee, Wisc
3 Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisc

CORRESPONDING AUTHOR: Linda N. Meurer, MD, MPH, Department of Family & Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, Wisconsin 53226, lmeurer{at}mcw.edu

PURPOSE We wanted to estimate excess risk of in-hospital mortality associated with medical injuries identified using an injury surveillance system, after controlling for risk of death resulting from comorbidities.

METHODS The Wisconsin Medical Injuries Prevention Program (WMIPP) screening criteria were used to identify medical injuries, defined as "any untoward harm associated with a therapeutic or diagnostic healthcare intervention," among discharge diagnoses for all 562,317 patients discharged from 134 acute care hospitals in Wisconsin in 2002. We then derived estimates for crude and adjusted relative risk of in-hospital mortality associated with the presence of a medical injury diagnosis. Logistic regression adjusted for baseline risk of mortality using a comorbidity index, age, sex, Diagnosis Related Groups, hospital characteristics, and clustering within hospital.

RESULTS There were 77,666 discharges that met WMIPP criteria for at least 1 medical injury (13.8%). Crude risk ratios for death ranged from 1.27 to 2.4 for those with medical injuries within 1 of 4 categories: drugs/biologics; devices, implants, and grafts; procedures; and radiation. After adjustment, estimates of excess mortality decreased, and significance persisted only for injuries related to procedures (39%; 95% confidence interval [CI], 28%–52%) and devices, implants, and grafts (16%; 95% CI, 3%–30%).

CONCLUSIONS Estimates of excess mortality that do not account for baseline mortality risk may be exaggerated. Findings have implications for the care family physicians provide in the hospital and for the advice they give their patients who are concerned about the risks of hospitalization.

Key Words: Hospital mortality • safety, medical device • medication errors • postoperative complications • adverse effects • iatrogenic disease • comorbidity • medical errors • quality of health care • research methods




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