Postop Events: Failure to Rescue Drives Mortality

FORT MYERS, FLA. — The difference between successful and unsuccessful treatment of patients for postsurgical complications may help account for the wide variability in mortality rates following major surgery at hospitals nationwide, according to a retrospective study of data for more than 12,000 patients.

“High-mortality hospitals have mortality rates similar to those of low-mortality hospitals but markedly higher failure-to-rescue rates,” Dr. Amir A. Ghaferi said at the annual Academic Surgical Congress.

The failure-to-rescue rate (i.e., mortality following the development of a postsurgical complication) for high-mortality hospitals was more than twice that for low-mortality hospitals—26% versus 11%, respectively. “When we evaluated individual complications, this trend persisted,” said Dr. Ghaferi, a surgical resident at the University of Michigan, Ann Arbor.

Wide variability in mortality rates following major surgery has been noted previously. Dr. Ghaferi and his coinvestigators hypothesized that hospitals with higher mortality rates are less effective than low-mortality hospitals in rescuing patients, once they develop complications, and that this could account for some of the variability.

To test their hypothesis, they analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program for all patients undergoing colectomy in 2005-2006. Data were available for 12,688 patients. Primary outcomes included 30-day mortality, the development of one of nine major postoperative complications (pneumonia, unplanned intubation, pulmonary embolism, myocardial infarction, acute renal failure, postoperative bleeding, deep wound infection, organ-space infection, and fascial dehiscence), and the mortality rates following each of these complications.

In all, 123 hospitals were grouped into quintiles by their risk-adjusted mortality rates. The investigators controlled 27 variables in the risk-adjustment model, including age, sex, race, and American Society of Anesthesiologists physical status classification. Risk-adjusted mortality rates ranged from 1.5% to 7.4% across the groups. Next, they compared complication rates for the nine common postoperative complications across the groups, as well as failure-to-rescue rates (i.e., rates of death caused by any of the nine postoperative complications).

A total of 51% of patients were female, and most (81%) were white, with a mean body mass index of 27 kg/m

High-mortality hospitals had a 1.5-fold greater risk of postsurgical complications: 16.2% in the high-mortality group, compared with 12.7% in the low-mortality group. “This cannot explain the nearly threefold mortality rate difference across our hospitals. However, when we looked at the failure-to-rescue rate, there's an astonishing difference,” he said.

“Many existing policies, which are aimed at reducing the incidence of complications, may not be able to reduce this observed variation in mortality. Rather, we may need to focus on the timely recognition and management of complications once they occur. The next step will be to develop a better understanding of the hospital resources and processes of care that lead to rescue from postsurgical complications.”

Dr. Ghaferi reported that he has no relevant financial relationships.

FORT MYERS, FLA. — The difference between successful and unsuccessful treatment of patients for postsurgical complications may help account for the wide variability in mortality rates following major surgery at hospitals nationwide, according to a retrospective study of data for more than 12,000 patients.

“High-mortality hospitals have mortality rates similar to those of low-mortality hospitals but markedly higher failure-to-rescue rates,” Dr. Amir A. Ghaferi said at the annual Academic Surgical Congress.

The failure-to-rescue rate (i.e., mortality following the development of a postsurgical complication) for high-mortality hospitals was more than twice that for low-mortality hospitals—26% versus 11%, respectively. “When we evaluated individual complications, this trend persisted,” said Dr. Ghaferi, a surgical resident at the University of Michigan, Ann Arbor.

Wide variability in mortality rates following major surgery has been noted previously. Dr. Ghaferi and his coinvestigators hypothesized that hospitals with higher mortality rates are less effective than low-mortality hospitals in rescuing patients, once they develop complications, and that this could account for some of the variability.

To test their hypothesis, they analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program for all patients undergoing colectomy in 2005-2006. Data were available for 12,688 patients. Primary outcomes included 30-day mortality, the development of one of nine major postoperative complications (pneumonia, unplanned intubation, pulmonary embolism, myocardial infarction, acute renal failure, postoperative bleeding, deep wound infection, organ-space infection, and fascial dehiscence), and the mortality rates following each of these complications.

In all, 123 hospitals were grouped into quintiles by their risk-adjusted mortality rates. The investigators controlled 27 variables in the risk-adjustment model, including age, sex, race, and American Society of Anesthesiologists physical status classification. Risk-adjusted mortality rates ranged from 1.5% to 7.4% across the groups. Next, they compared complication rates for the nine common postoperative complications across the groups, as well as failure-to-rescue rates (i.e., rates of death caused by any of the nine postoperative complications).

A total of 51% of patients were female, and most (81%) were white, with a mean body mass index of 27 kg/m

High-mortality hospitals had a 1.5-fold greater risk of postsurgical complications: 16.2% in the high-mortality group, compared with 12.7% in the low-mortality group. “This cannot explain the nearly threefold mortality rate difference across our hospitals. However, when we looked at the failure-to-rescue rate, there's an astonishing difference,” he said.

“Many existing policies, which are aimed at reducing the incidence of complications, may not be able to reduce this observed variation in mortality. Rather, we may need to focus on the timely recognition and management of complications once they occur. The next step will be to develop a better understanding of the hospital resources and processes of care that lead to rescue from postsurgical complications.”

Dr. Ghaferi reported that he has no relevant financial relationships.

FORT MYERS, FLA. — The difference between successful and unsuccessful treatment of patients for postsurgical complications may help account for the wide variability in mortality rates following major surgery at hospitals nationwide, according to a retrospective study of data for more than 12,000 patients.

“High-mortality hospitals have mortality rates similar to those of low-mortality hospitals but markedly higher failure-to-rescue rates,” Dr. Amir A. Ghaferi said at the annual Academic Surgical Congress.

The failure-to-rescue rate (i.e., mortality following the development of a postsurgical complication) for high-mortality hospitals was more than twice that for low-mortality hospitals—26% versus 11%, respectively. “When we evaluated individual complications, this trend persisted,” said Dr. Ghaferi, a surgical resident at the University of Michigan, Ann Arbor.

Wide variability in mortality rates following major surgery has been noted previously. Dr. Ghaferi and his coinvestigators hypothesized that hospitals with higher mortality rates are less effective than low-mortality hospitals in rescuing patients, once they develop complications, and that this could account for some of the variability.

To test their hypothesis, they analyzed data from the American College of Surgeons' National Surgical Quality Improvement Program for all patients undergoing colectomy in 2005-2006. Data were available for 12,688 patients. Primary outcomes included 30-day mortality, the development of one of nine major postoperative complications (pneumonia, unplanned intubation, pulmonary embolism, myocardial infarction, acute renal failure, postoperative bleeding, deep wound infection, organ-space infection, and fascial dehiscence), and the mortality rates following each of these complications.

In all, 123 hospitals were grouped into quintiles by their risk-adjusted mortality rates. The investigators controlled 27 variables in the risk-adjustment model, including age, sex, race, and American Society of Anesthesiologists physical status classification. Risk-adjusted mortality rates ranged from 1.5% to 7.4% across the groups. Next, they compared complication rates for the nine common postoperative complications across the groups, as well as failure-to-rescue rates (i.e., rates of death caused by any of the nine postoperative complications).

A total of 51% of patients were female, and most (81%) were white, with a mean body mass index of 27 kg/m

High-mortality hospitals had a 1.5-fold greater risk of postsurgical complications: 16.2% in the high-mortality group, compared with 12.7% in the low-mortality group. “This cannot explain the nearly threefold mortality rate difference across our hospitals. However, when we looked at the failure-to-rescue rate, there's an astonishing difference,” he said.

“Many existing policies, which are aimed at reducing the incidence of complications, may not be able to reduce this observed variation in mortality. Rather, we may need to focus on the timely recognition and management of complications once they occur. The next step will be to develop a better understanding of the hospital resources and processes of care that lead to rescue from postsurgical complications.”

Dr. Ghaferi reported that he has no relevant financial relationships.