Does hospital mortality rate reflect quality of care on a surgical unit?

All deaths occurring in 1 year in the surgical unit of a district general hospital were analysed to determine to what extent crude mortality rates reflect the quality of care. There were 166 deaths, 70% of patients were aged 75 years and older, and 87.3% were emergency admissions. Almost one-half (46.4%) of the deaths were inevitable. This high proportion of inevitable deaths means that crude hospital mortality rates are a poor indicator of the quality of surgical care. Factors such as the nature of the catchment area served, the proportion of emergency versus elective admissions, the numbers of complex operations performed and the availability of convalescent or hospice facilities are a greater influence on surgical mortality rates than variations in the standard of surgical care. The use of crude hospital mortality rates to compare the quality of care given by surgical units should be discontinued as it is unreliable and misleading.