Failure to rescue in emergency general surgery in Canada. Can J Surg 2022;65(2):E215-E220
Date
03/24/2022Pubmed ID
35318241Pubmed Central ID
PMC9259385DOI
10.1503/cjs.008820Scopus ID
2-s2.0-85126877594 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
BACKGROUND: The risk of death after a postoperative complication - known as failure to rescue (FTR) - has been proposed to be superior to traditional benchmarking outcomes, such as complication and mortality rates, as a measure of system quality. The purpose of this study was to identify the current FTR rate in emergency general surgery (EGS) centres across Canada. We hypothesized that substantial variability exists in FTR rates across centres.
METHODS: In this multicentre retrospective cohort study, we performed a secondary analysis of data from a previous study designed to evaluate operative intervention for nonappendiceal, nonbiliary disease by 6 EGS services across Canada (1 in British Columbia, 1 in Alberta, 3 in Ontario and 1 in Nova Scotia). Patients underwent surgery between Jan. 1 and Dec. 31, 2014. We conducted univariate analyses to compare patients with and without complications. We performed a sensitivity analysis examining the mortality rate after serious complications (Clavien-Dindo score 3 or 4) that required a surgical intervention or specialized care (e.g., admission to intensive care unit).
RESULTS: A total of 2595 patients were included in the study cohort. Of the 206 patients who died within 30 days, 145 (70.4%) experienced a complication before their death. Overall, the mortality rate after any surgical complication (i.e., FTR) was 16.0%. Ranking of sites by the traditional outcomes of complication and mortality rates differed from the ranking when FTR rate was included in the assessment.
CONCLUSION: There was variability in FTR rates across EGS services in Canada, which suggests that there is opportunity for ongoing quality-improvement efforts. This study provides FTR benchmarking data for Canadian EGS services.
Author List
Minor S, Allen L, Meschino MT, Nenshi R, van Heest R, Saleh F, Widder S, Engels PT, Joos E, Parry NG, Murphy PB, Ball CG, Hameed M, Vogt KN, Canadian Collaborative on Urgent Care SurgeryAuthor
Patrick Murphy MD Assistant Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AlbertaFailure to Rescue, Health Care
General Surgery
Hospital Mortality
Humans
Postoperative Complications
Quality Improvement
Retrospective Studies