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Silber,

doi:10.1016/s1353-4505(97)00007-0

Cited by 3 publications

(3 citation statements)

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“…(9, 11, 12) However, in contrast to our analysis, prior studies have not controlled for the presence of standardized hospital safety programs set up to identify and treat complications. Hospitals that reported full NQF safe practice compliance were expected to have surveillance programs for detecting postoperative complications such as surgical site infections, adverse cardiac events, and thromboembolic events, which likely increased detection of these complications in our study (Table 4).…”

Section: Discussionmentioning

confidence: 91%

Variations in surgical outcomes associated with hospital compliance with safety practices

Brooke

Dominici

Pronovost

et al. 2012

Surgery

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Background The Leapfrog Group aims to improve patient safety by promoting hospital compliance with National Quality Forum (NQF) safe practices. It is unknown, however, whether implementation of these safety practices improve outcomes following high-risk operations. Methods We conducted a cross-sectional analysis of 658 nationwide hospitals that responded to the 2005 Leapfrog Group Hospital Quality & Safety survey. A total of 79,462 patients were identified from Medicare claims data who underwent a pancreatectomy, hepatectomy, esophagectomy, open aortic aneurysm repair, colectomy or gastrectomy procedure from 2004 through 2006. Random-effects logistic regression models were used to estimate the association between hospital compliance with NQF safe practices and risk-adjusted odds of complications, failure rate to rescue, and mortality after adjusting for patient and hospital level confounders. Results Of the 658 hospitals that responded to surveys, 41% had fully implemented NQF safe practices and 59% reported partial compliance with these standards. Compared to hospitals with partial NQF compliance, we found significant evidence that hospitals with full compliance had an increased likelihood of diagnosing a complication following any of the six high-risk operations (OR: 1.13; 95%CI: 1.03–1.25), but had a decreased likelihood of failure to rescue (OR: 0.82; 95%CI: 0.71–0.96), and a decreased odds of mortality (OR: 0.80; 95%CI: 0.71–0.91). Conclusions Despite having a higher rate of postoperative complications, hospitals fully complying with safe practices were associated with lower failure to rescue and reduced mortality following high-risk operations. These results highlight the importance of having hospitals systems in place to promote safety and manage postoperative complications.

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Section: Discussionmentioning

confidence: 91%

Variations in surgical outcomes associated with hospital compliance with safety practices

Brooke

Dominici

Pronovost

et al. 2012

Surgery

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“…The FTR rate has several potential advantages over more convention outcome metrics. While it has been repeatedly shown that center level SAE rates correlate poorly with center level mortality rates (4, 5), center level FTR rates are strongly associated with center level mortality across a wide variety of elective surgical populations (6–8). Moreover, relative to risk of SAE, risk of FTR is more strongly associated with potentially modifiable center level factors such as staffing patterns and infrastructure (9).…”

Section: Introductionmentioning

confidence: 99%

Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury

Earl-Royal

Kaufman

Hsu

et al. 2016

Journal of Surgical Research

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Introduction Failure to rescue (FTR: the conditional probability of death after complication) has been studied in trauma cohorts, but the impact of age and pre-existing conditions (PECs) on risk of FTR is not well-known. We assessed the relationship between age and PECs on the risk of experiencing serious adverse events (SAE) subsequent FTR in trauma patients with the hypothesis that increased comorbidity burden and age would be associated with increased FTR. Materials and Methods We performed a retrospective cohort analysis at an urban level 1 trauma center in PA. All patients age ≥ 16 years with minimum abbreviated injury scale score ≥ 2 from 2009–2013 were included. Univariate logistic regression models for SAE and FTR were developed using age, PECs, demographics, and injury physiology. Variables found to be associated with the endpoint of interest (p≤0.2) in univariate analysis were included in separate multivariable logistic regression models for each outcome. Results SAE occurred in 1,136/7533 (15.1 %) of patients meeting inclusion criteria (median age 42 (IQR 26–59), 53% African American, 72% male, 79% blunt, median ISS 10 (IQR 5–17)). Of those who experienced a SAE, 129/1136 patients subsequently died (FTR = 11.4%). Development of SAE and FTR was associated with age ≥ 70 (OR 1.58–1.78, 95% CI 1.13–2.82). Renal disease was the only pre-existing condition associated with both SAE and FTR. Conclusions Trauma patients with renal disease are most at increased risk for both SAE and FTR, but other PECs associated with SAE are not necessarily those associated with FTR. Future interventions designed to reduce FTR events should target this high-risk cohort.

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“…Failure-to-rescue is defined as death occurring after a complication 1 and has been shown to correlate better with inhospital mortality than the complication rates alone after cardiac surgery, 2,3 vascular surgery, 4,5 general surgery, 4,6 pancreatectomy, 7,8 pulmonary resection, 9 and surgery for head and neck cancer. 10 Recently, this relationship also has been demonstrated after traumatic injury.…”

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confidence: 99%

Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma

Kuo

Kaufman

Hoffman

et al. 2017

Surgery

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Background Failure-to-rescue is defined as the conditional probability of death after a complication, and the failure-to-rescue rate reflects a center’s ability to successfully “rescue” patients after complications. The validity of the failure-to-rescue rate as a quality measure is dependent on the preventability of death and the appropriateness of this measure for use in the trauma population is untested. We sought to evaluate the relationship between preventability and failure-to-rescue in trauma. Methods All adjudications from a mortality review panel at an academic level I trauma center from 2005–2015 were merged with registry data for the same time period. The preventability of each death was determined by panel consensus as part of peer review. Failure-to-rescue deaths were defined as those occurring after any registry-defined complication. Univariate and multivariate logistic regression models between failure-to-rescue status and preventability were constructed and time to death was examined using survival time analyses. Results Of 26,557 patients, 2,735 (10.5%) had a complication, of whom 359 died for a failure-to-rescue rate of 13.2%. Of failure-to-rescue deaths, 272 (75.6%) were judged to be non-preventable, 65 (18.1%) were judged potentially preventable, and 22 (6.1%) were judged to be preventable by peer review. After adjusting for other patient factors, there remained a strong association between failure-to-rescue status and potentially preventable (odds ratio 2.32, 95% confidence interval, 1.47–3.66) and preventable (odds ratio 14.84, 95% confidence interval, 3.30–66.71) judgment. Conclusion Despite a strong association between failure-to-rescue status and preventability adjudication, only a minority of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable. Revision of the failure-to-rescue metric before use in trauma care benchmarking is warranted.

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Abstract: For general surgical procedures, hospital rank using the complication rate is poorly correlated with rankings using the death or failure rate. Complication rates should be used with great caution and should not be used in isolation when assessing hospital quality of care.

Cited by 3 publications

References 0 publications

Variations in surgical outcomes associated with hospital compliance with safety practices

Variations in surgical outcomes associated with hospital compliance with safety practices

Age and preexisting conditions as risk factors for severe adverse events and failure to rescue after injury

Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma

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