The analysis also found that the average length of stay for hospitalized surgical patients increased by almost one full day between 2019 and 2024. This trend correlates with both higher patient acuity and a growing trend of delayed discharges for post-acute care.

According to the analysis, discharge delays are also due to prior authorization requirements or inadequate post-acute provider networks in Medicare Advantage (MA) plans. Between 2019 and 2024, the average length of stay prior to discharge to post-acute care doubled for MA patients compared to traditional Medicare patients, growing from 6.4% to 12.6%.

Commentary

According to David Levine, SVP and CMO for Vizient, the results of the analysis "reflect the extraordinary efforts by hospitals to adapt and elevate surgical care."

"By leveraging advanced analytics and technology-driven insights, health systems are not only addressing the increasing complexity of inpatient surgical cases but are improving outcomes in meaningful, measurable ways," Levine added.

Similarly, AHA president and CEO Rick Pollack said that "[t]he safety and quality improvements in surgical outcomes underscore the resilience and unwavering commitment of hospitals and health systems — and the millions of hospital team members across the country — to delivering better care to the patients and communities they serve."

However, Pollack also noted that "[w]hile hospitals are proud of these efforts, we know there is always more work to do to deliver the highest quality care possible."

How hospitals are boosting surgical safety (and how to sustain it)

By Loree Eysaman  and Anne Schmidt 

AHA and Vizient’s findings mark a critical inflection point in surgical care: Hospitals are achieving substantial gains in patient safety despite rising acuity and clinical complexity. A nearly 20% reduction in surgical mortality, alongside double-digit declines in post-operative sepsis, respiratory failure, and hemorrhage, reflects disciplined execution across safety protocols and care delivery.

Expanded protocols and standardization

A one-day increase in average length of stay may indicate a shift toward more complex surgical populations. Despite this, outcomes continue to improve where standardization and acuity-adjusted protocols drive measurable results, highlighting the value of targeted care variation reduction. 

Improvements reflect deliberate strategies, such as reimplementation of the WHO Surgical Safety Checklist, standardization of high-risk workflows, and team-based safety culture interventions. Hospitals are increasingly using frameworks like the Agency for Healthcare Research and Quality’s Translating Research into Practice framework to ensure fidelity and scalability of evidence-based protocols, such as the Methicillin-Resistant Staphylococcus Aureus decolonization toolkit, within perioperative services.

Additionally, Enhanced Recovery After Surgery (ERAS) protocols, once limited to colorectal procedures, are becoming a standard of practice across spine, orthopedics, cardiac, urology, and vascular specialties. The expansion has accelerated recovery, reduced post-operative complications, and improved discharge success. Post-operative ambulation is also a core expectation and contributes to reduced post-operative length of stay and enhanced functional outcomes. Interventions reflect a deliberate move toward accurate recovery strategies tailored to surgical complexity.

Patient preparation and management

Patient preparation is critical for safety and success. Elective cases routinely undergo pre-admission testing to optimize the management of blood glucose, hypertension, and other comorbidities before surgery. The proactive approach improves intraoperative stability, accelerates recovery, reduces post-operative complications, and improves discharge success.  Additionally, the standardized use of chlorhexidine gluconate body washes, performed before hospital arrival and again on the morning of surgery and at the surgical site, has significantly reduced surgical site infections , reinforcing the value of evidence-based hygiene protocols.

Equally critical is the role of patient engagement. When patients are involved in pre-operative planning, including education, comorbidity optimization, and shared decision-making, they contribute meaningfully to safer recoveries. Prehabilitation, expectation-setting, and individualized coordination have all been shown to reduce complications and improve discharge success. Surgical safety is both a hospital achievement and a shared responsibility.

Throughput remains a critical metric and should be actively managed, particularly for patients who are clinically ready to “launch” and can safely transition to the next phase of care. At the same time, extended inpatient stays, when aligned with patient needs and resulting in a successful discharge home (or home with home health), can represent meaningful value. Length-of-stay benchmarks and payment models should evolve to reflect both efficient throughput and functional recovery. Value must be defined not only by speed, but by the durability of outcomes. Evidence from outcome-based care models confirms that this approach can reduce total cost of care while improving quality across diverse settings.

Organizational next steps

Surgical demand is rising. To sustain performance, organizations must scale high-reliability systems, reduce variation, and strengthen care coordination. Payment models should evolve to reward outcomes, while still recognizing the importance of efficient throughput. Creating standard work, building strong partnerships, and empowering patients are now strategic imperatives.

To continue improving, hospitals should expand ERAS protocols, optimize pre-operative preparation and engage patients early, as well as develop efficient models to improve performance. Track what matters. Invest in teams through structured training and shared accountability. These are the levers of durable surgical safety.