Failure to rescue as a source of variation in hospital mortality after hepatic surgery

Spolverato, Gaya; Ejaz, Aslam; Hyder, Omar; Kim, Y.; Pawlik, Timothy M.

doi:10.1002/bjs.9492

Cited by 107 publications

(75 citation statements)

References 51 publications

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“…Evidence for this is the difference between our overall rate of all esophageal anastomotic leaks (14.7%) and our rate of major leaks requiring invasive treatment (10%), which is in keeping with other published results, including a previous study from our institution focusing on a specific reconstruction technique (27). The data suggest that high volume institutions have lower complication rates and post-operative mortality rates, which may be attributed to earlier recognition and rescue from AEs (13, 25, 26, 31), a phenomenon likely related to experience in dealing with the post-operative AEs when they do occur.…”

Section: Discussionmentioning

confidence: 91%

Morbidity after Total Gastrectomy: Analysis of 238 Patients

Selby

Vertosick

Sjoberg

et al. 2015

Journal of the American College of Surgeons

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Background Surgical quality improvement requires well-defined benchmarks and accurate reporting of postoperative adverse events, which have not been well defined for total gastrectomy. Study Design Detailed post-operative outcomes on 238 patients who underwent curative intent total gastrectomy from 2003 – 2012 were reviewed by a dedicated surgeon chart reviewer to establish the 90-day patterns of adverse events. Results Of the 238 patients with stage I – III gastric adenocarcinoma who underwent curative intent total gastrectomy, the median age was 66, and 68% were male. Median body mass index was 28, and 68% of patients had at least one medical comorbidity. Forty three percent of our patients received neoadjuvant chemotherapy, and 34% received post-operative adjuvant chemotherapy. Over the 90 day study period, 30-day mortality was 2.5% (6/238), and 90-day mortality was 2.9% (7/238). At least one post-operative adverse event was documented in 62% of patients, with 28% of patients experiencing a major adverse event requiring invasive intervention. The readmission rate was 20%. Anemia was the most common adverse event (20%), followed by wound complications (18%). The most common major adverse event was esophageal anastomotic leak, which required invasive intervention in 10% of patients. Conclusion This analysis has defined comprehensive 90-day patterns in post-operative adverse events following curative intent total gastrectomy in a Western population. This benchmark allows surgeons to measure, compare, and improve outcomes and informed consent for this surgical procedure.

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Section: Discussionmentioning

confidence: 91%

Morbidity after Total Gastrectomy: Analysis of 238 Patients

Selby

Vertosick

Sjoberg

et al. 2015

Journal of the American College of Surgeons

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“…8 Improvements in surgical techniques and perioperative management have resulted in decreased postoperative mortality, but morbidity remains high, ranging from 20% to 56% depending on patient comorbidities as well as hospital and surgeon volume. 18,[22][23][24] The impact of postoperative complications on long-term outcome has been evaluated among patients undergoing hepatic resection for colorectal liver metastasis. 18,20,22,24,25 However, to the best of our knowledge, the impact of perioperative morbidity on the longterm prognosis of patients with ICC undergoing surgical resection has not been previously studied.…”

Section: Discussionmentioning

confidence: 99%

Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Spolverato

Yakoob

Kim

et al. 2015

Cancer

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BACKGROUND:The impact of postoperative complications on the long-term outcomes of patients undergoing surgery for cancer is unclear. The objective of the current study was to define the incidence of complications among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) and identify the association between morbidity and long-term outcomes. METHODS: A total of 583 patients undergoing surgery with curative intent for ICC between 1990 and 2013 at 1 of 12 participating institutions were identified. The association between the occurrence and severity of postoperative complications on long-term survival was analyzed. RESULTS: The median age of the patients was 59.9 years and the majority of patients were male (52.3%). A total of 91 patients (15.6%) and 153 patients (26.2%) developed a major and minor postoperative complication, respectively; 18 patients (3.5%) died within 90 days of surgery. Median, 1-year, 3-year, and 5-year recurrence-free survival were 10.0 months, 43.3%, 16.7%, and 11.1%, respectively. Postoperative complications (hazard ratio [HR] CONCLUSIONS: Postoperative complications were found to be independent predictors of worse long-term outcomes. The prevention and management of postoperative complications is crucial to increase both short-term and long-term survival. Cancer 2015;121:2730-9.

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“…7,18,19 Additionally, a nationwide study in Denmark has previously demonstrated variation in mortality after colorectal cancer surgery that is related to the ability of hospitals to care for emergency patients and those with high ASA classification. 20 While there is substantial evidence regarding identification of failure to rescue, there is much less evidence regarding ways to improve recognition and treatment of complications once they occur.…”

Section: Discussionmentioning

confidence: 99%

Colon cancer operations at high- and low-mortality hospitals

Healy

Grenda

Suwanabol

et al. 2016

Surgery

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Introduction There is wide variation in mortality across hospitals for cancer surgery. While higher rates of mortality are commonly ascribed to high-risk resections, the impact on more common operations is unclear. We sought to evaluate causes of mortality following colon cancer operations across hospitals. Methods 49 American College of Surgeons Commission on Cancer (ACS-CoC) hospitals were selected for participation in a CoC special study. We ranked hospitals using a composite measure of mortality and performed onsite chart reviews. We examined patient characteristics and mortality following colon resections at very high mortality (HMH) and very low mortality (LMH) hospitals (2006–2007). Results We identified 3,025 patients who underwent surgery at 19 LMHs (n = 1,006) and 30 HMHs (n = 2,019). There were wide differences in risk-adjusted mortality between HMHs and LMHs (9.3% vs. 2.4%; P<0.001). Compared to LMHs, HMHs had more patients who were black (11.2% vs. 6.5%; P<0.001), had ≥2 comorbidities (22.7% vs. 18.9%; P<0.05), ASA class 4–5 (11.9% vs. 5.3%; P<0.001), and were functionally dependent (13.9% vs. 8.8%; P<0.001). Rates of any complication were similar in HMH’s vs. LMH’s (OR 1.29, 95% CI: 0.85 – 1.95). But, for those experiencing complications, case fatality rates were statistically significantly higher in HMHs vs. LMHs (OR 3.74, 95% CI: 1.59 – 8.82). Conclusions There is significant variation in mortality across hospitals for colon cancer surgery, despite similar perioperative morbidity. This finding reflects a need for improved surgical decision-making to enhance outcomes and quality of care at these hospitals.

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Failure to rescue as a source of variation in hospital mortality after hepatic surgery

Abstract: The risk of death following hepatic surgery is lower at high-volume hospitals. The reduction in mortality appears to be the result of both lower complication rates and a better ability in high-volume hospitals to rescue patients with major complications.

Cited by 107 publications

References 51 publications

Morbidity after Total Gastrectomy: Analysis of 238 Patients

Morbidity after Total Gastrectomy: Analysis of 238 Patients

Impact of complications on long‐term survival after resection of intrahepatic cholangiocarcinoma

Colon cancer operations at high- and low-mortality hospitals

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