Use of resources and postoperative outcome.

OBJECTIVE: To characterise those surgical patients who consume one half of all hospital patient days, and to compare their outcome with that of low consumers. DESIGN: A retrospective cohort study. SETTING: Tertiary referral centre, Finland. PATIENTS: 13025 surgical patients who were admitted to a university hospital in Kuopio, Finland, during 1997. INTERVENTIONS: The length of stay below which half of all patient days fell was chosen as a cut-off value to divide patients into low and high consumers. MAIN OUTCOME MEASURES: Hospital and 12-month mortality and standardised mortality ratios (SMR: observed deaths/expected deaths based on the corresponding general population). RESULTS: The 2239 patients (17%) whose length of stay exceeded 9 days (high consumers) took up one half of all patient days. The pattern of resource use varied between operative specialities. At 12 months the SMRs showed excess mortality among high consumers (5.0, 95% confidence interval 4.4 to 5.7) compared with low consumers (2.1, 95% CI 1.9 to 2.3). CONCLUSIONS: Relating the length of stay to the proportion of resources consumed may provide a feasible tool for the recognition of different patterns of use of resources. SMRs may be more relevant measures of outcome than hospital mortality when assessing the efficacy of operative treatment.