More data on post-surgical deaths related to the 1976 Los Angeles doctor slowdown

Abstract

A previous report showed steady decline in the death rate during a ‘doctor slowdown’ (involving essentially the withholding of elective surgery) in Los Angeles County, California—followed by a sharp rise in the death rate as soon as ‘surgery as usual’ was resumed. To determine if this sequence was, in fact, related to post-operative deaths, the actual death certificates for the fortnight after the 1976 slowdown ( N = 2574) and those for the corresponding period of 1975 ( N = 2663) were examined. Most death certificates, of course, had no indication of surgery done, but comparing deaths associated with surgery in the two periods showed 90 more such deaths in 1976 than in 1975. Separate study of a sample of local hospitals showed withholding of nearly 11,000 elective operations during the slowdown. A widely used average post-operative case-fatality rate for elective surgery of 0.50% would imply avoidance of 55 deaths. The finding of 90 excess deaths associated with surgery in 1976, compared with 1975, therefore, suggests strongly that the sudden rise in the overall Los Angeles County death rate, following the 1976 doctor slowdown, was indeed due, at least in part, to the performance of postponed surgical procedures.