Failure to Rescue After Abdominal Surgery: an Audit on Incidence and Predictors
Abstract
IntroductionFailure-to-rescue (FTR), defined as death after a surgical complication, is a quality metric that is an important variable affecting mortality rates in hospitals. This study aims to analyze complications, FTR rates, and its predictors at the index hospital setting.
Methods
This was a retrospective cohort study performed at an academic hospital from 2015 to 2020 in the Department of Surgical Gastroenterology. We included all patients who had major complications following elective major benign or malignant abdominal surgeries. The primary and secondary endpoint was FTR rates and the overall major complications and deaths, re-operation rate, and its predictors respectively.
Results
Among 762 patients, the rate of any major complication was 14.9% . The overall mortality rate was 2.8%. However, the mortality rate among patients with complications was 27.4% (FTR). Twenty-seven (52.9%) patients underwent re-operation for complications, out of which 70% survived. Three (21.4%) patients had a delay in prompt diagnosis and interventions of complications and had FTR due to the anastomotic leak and bleeding. The ASA grade, co-morbidities,, re-operation, and nature of the disease (benign vs. malignant) did not predict the FTR.
Conclusion
This study conducted at an academic, low-volume center had higher rates of FTR. It can be further reduced by both prompt and appropriate interventions of postoperative complications in a multidisciplinary setup.
References
1. 1. Abe T, Komori A, Shiraishi A, Sugiyama T, Iriyama H, Kainoh T, et al. Trauma complications and in-hospital mortality: failure-to-rescue. Crit Care. 2020;24(1):223.
2. Rosero EB, Modrall JG, Joshi GP. Failure to rescue after major abdominal surgery: The role of hospital safety net burden. Am J Surg. 2020;220(4):1023–30.
3. Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care. 2011;49(12):1076–81.
4. Krautz C, Gall C, Gefeller O, Nimptsch U, Mansky T, Brunner M, et al. In-hospital mortality and failure to rescue following hepatobiliary surgery in Germany - a nationwide analysis. BMC Surg. 2020;20(1):1–11.
5. Schneider EB, Ejaz A, Spolverato G, Hirose K, Makary MA, Wolfgang CL, et al. Hospital Volume and Patient Outcomes in Hepato-Pancreatico-Biliary Surgery: Is Assessing Differences in Mortality Enough? J Gastrointest Surg. 2014;18(12):2105–15.
6. Lillo-felipe M, Hulme RA, Bchir MB, Sjolin G, Cao Y, Bass GA, et al. Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery. Surgery. 2021;170(3):863-9.
7. Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014;260(2):244–51.
8. Shah R, Attwood K, Arya S, Hall DE, Johanning JM, Gabriel E, et al. Association of frailty with failure to rescue after low-risk and high-risk inpatient surgery. JAMA Surg. 2018;153(5):e180214..
9. Gleeson EM, Clarke JR, Morano WF, Shaikh MF, Bowne WB, Pitt HA. Patient-specific predictors of failure to rescue after pancreaticoduodenectomy. Hpb. 2019;21(3):283–90.
2. Rosero EB, Modrall JG, Joshi GP. Failure to rescue after major abdominal surgery: The role of hospital safety net burden. Am J Surg. 2020;220(4):1023–30.
3. Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and failure to rescue with high-risk surgery. Med Care. 2011;49(12):1076–81.
4. Krautz C, Gall C, Gefeller O, Nimptsch U, Mansky T, Brunner M, et al. In-hospital mortality and failure to rescue following hepatobiliary surgery in Germany - a nationwide analysis. BMC Surg. 2020;20(1):1–11.
5. Schneider EB, Ejaz A, Spolverato G, Hirose K, Makary MA, Wolfgang CL, et al. Hospital Volume and Patient Outcomes in Hepato-Pancreatico-Biliary Surgery: Is Assessing Differences in Mortality Enough? J Gastrointest Surg. 2014;18(12):2105–15.
6. Lillo-felipe M, Hulme RA, Bchir MB, Sjolin G, Cao Y, Bass GA, et al. Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery. Surgery. 2021;170(3):863-9.
7. Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014;260(2):244–51.
8. Shah R, Attwood K, Arya S, Hall DE, Johanning JM, Gabriel E, et al. Association of frailty with failure to rescue after low-risk and high-risk inpatient surgery. JAMA Surg. 2018;153(5):e180214..
9. Gleeson EM, Clarke JR, Morano WF, Shaikh MF, Bowne WB, Pitt HA. Patient-specific predictors of failure to rescue after pancreaticoduodenectomy. Hpb. 2019;21(3):283–90.
Published
2022-02-02
How to Cite
PANDIT, Narendra et al.
Failure to Rescue After Abdominal Surgery: an Audit on Incidence and Predictors.
J Soc Surg Nep, [S.l.], v. 24, n. 2, p. 42-45, feb. 2022.
ISSN 2392-4772.
Available at: <https://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=488>. Date accessed: 03 dec. 2024.
Section
Original Article
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