“Failure to Rescue” following Colorectal Cancer Resection

Abstract

Objective: To examine variation in “failure to rescue” (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. Background: Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences in mortality both between hospitals and over time are driven by variation in FTR. Methods: A national population-based study of patients undergoing colorectal cancer resection from 2010 to 2019 in Aotearoa New Zealand was conducted. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Twenty District Health Boards (DHBs) were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year period were examined. Results: Overall, 15,686 patients undergoing resection for colorectal adenocarcinoma were included. Increased postoperative mortality at high-mortality centers (OR 2.4, 95% CI 1.8–3.3) was driven by higher rates of FTR (OR 2.0, 95% CI 1.5–2.8), and postoperative complications (OR 1.4, 95% CI 1.3–1.6). These trends were consistent across operative and nonoperative complications. Over the 2010 to 2019 period, postoperative mortality halved (OR 0.5, 95% CI 0.4–0.6), associated with a greater improvement in FTR (OR 0.5, 95% CI 0.4–0.7) than complications (OR 0.8, 95% CI 0.8–0.9). Differences between centers and over time remained when only analyzing patients undergoing elective surgery. Conclusion: Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in “rescue” from complications. Differences in FTR also drive hospital-level variation in mortality, highlighting the central importance of “rescue” as a target for surgical quality improvement.

Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study

“…Patients who return to the operating theatre in the postoperative period experience some of the worst preventable complications. Our study has observed a reoperation rate of 5.8% for general surgical procedures, which is higher than research conducted in the United Kingdom and New Zealand (online supplemental table 7) 1 29…”

“…FTR is a significant driver of variations in postoperative mortality 1. We have shown that Norwegian hospitals varied in readmission rate, 30-day mortality and length of stay 12.…”

“…Failure to rescue (FTR) is defined as postoperative death following a surgical complication, and the FTR rate is an internationally accepted quality indicator 1–7. FTR reflects the ability of a hospital to provide appropriate care to surgical patients after a complication.…”

Characterising nationwide reasons for unplanned hospital readmission after colorectal cancer surgery

“…All patients aged over 18 years undergoing colorectal cancer resection in AoNZ public hospitals from January 1 2010 to December 31 2020 were identified using relevant Australian Classification of Health Intervention (ACHI) procedure codes. Diagnoses were verified using the New Zealand Cancer Registry (NZCR) using methods described in detail elsewhere [19]. Private hospital procedures and multivisceral resection were excluded from the cohort.…”

Nanoparticle Composites Comprised of Hyaluronic Acid-Decorated Metal–Organic Frameworks with Encapsulated l-Buthionine Sulfoximine and Chlorin e6 for Chemodynamic/Photodynamic Synergistic Cancer Therapy

“…Nowadays, the incidence of cancer has been considered as the major public health problem causing the death of humans worldwide. − Traditional modalities including surgery, radiotherapy, and chemotherapy remain the most widely adopted strategies for the fighting of local and metastatic tumors in clinic. − Nevertheless, these treatments still face many clinical bottlenecks such as poor tumor selectivity, undesired systemic toxicity, and serious adverse effects, resulting in the unfavorable therapeutic efficiency and the worse living quality of cancer-associated patients. − In addition, distinct from healthy tissues, the tumor microenvironment (TME) exhibited many particular features including vascular abnormalities, hypoxia, overexpression of glutathione (GSH), high level of endogenic hydrogen peroxide (H 2 O 2 ), and mild acidity, − which further aggrandized the challenge for the cure of cancer with ideal consequences. Therefore, innovative approaches are urgently demanded for effective anticancer therapy.…”