Skip to main content

Death among surgical inpatients with treatable serious complications (failure to rescue)

CBE ID
0200
Endorsement Status
1.0 New or Maintenance
1.1 Measure Structure
Previous Endorsement Cycle
Is Under Review
No
1.6 Measure Description

Percentage of surgical inpatients with complications of care whose status is death

    Measure Specs
      General Information
      1.7 Measure Type
      1.3 Electronic Clinical Quality Measure (eCQM)
      1.8 Level of Analysis
      1.9 Care Setting
      1.20 Types of Data Sources
      1.14 Numerator

      Surgical inpatients with complications of care whose discharge status is death

      1.15 Denominator

      Major surgical discharges with complications of care: sepsis (ICD-9-CM codes 038, 790.7), pneumonia (ICD-9-CM codes 507.0, 997.3, 514, 482, 485, 486), GI bleeding (ICD-9-CM codes 531.00-531.31,531.9,532.00-532.31, 532.9, 533.00-533.31,533.9, 534.00-534.31, 534.9, 535.01, 535.4, 578.9, 530.82), shock/cardiac arrest (ICD-9-CM codes 427.5, 785.5, 785.50, 785.51, 785.59, 799.1, 93.93, 99.60, 99.63), DVT/PE (ICD-9-CM codes 451.81, 451.11, 451.19, 415.11, 415.1, 453.8)

      Exclusions

      Exclusions as noted for each complication of care :
      Sepsis excluding sepsis as a primary diagnosis, AIDS and immunocompromised states, LOS 3 days, infection related admission
      Pneumonia excluding any primary diagnosis of pneumonia, any secondary diagnosis of ICD-9-CM 480, 481, 483, 484, 487, MDC4 (respiratory system), AIDS and immunocompromised states
      GI Bleeding excluding primary GI bleed as a primary diagnosis, MDC 6 (digestive tract), MDC 7 (hepatobiliary tract and pancreas), primary diagnosis of anemia due to blood loss, trauma, burn, alcoholism
      Shock/cardiac arrest excluding shock as primary diagnosis, MDC 4 (respiratory), MDC 5 (cardiac), hemorrhage or trauma as a primary diagnosis
      DVT/PE excluding DVT/PE as a primary diagnosis and pregnancy related PE

      Most Recent Endorsement Activity
      Measure Retired and Endorsement Removed Surgical Consensus Standards Endorsement Maintenance
      Initial Endorsement
      Last Updated
      Removal Date
      Steward Organization
      Agency for Healthcare Research and Quality
      Steward POC email
      Pam.Owens@ahrq.hhs.gov
              Risk Adjustment
                  Public Comments