Faculty Collaboration Database

Improving mortality following emergent surgery in older patients requires focus on complication rescue. Ann Surg 2013 Oct;258(4):614-7; discussion 617-8

Date

08/28/2013

Pubmed ID

23979275

Pubmed Central ID

PMC4181566

DOI

10.1097/SLA.0b013e3182a5021d

Scopus ID

2-s2.0-84884473131 (requires institutional sign-in at Scopus site)   57 Citations

Abstract

OBJECTIVE: To determine whether a hospital's ability to rescue patients from major complications underlies variation in outcomes for elderly patients undergoing emergent surgery.

BACKGROUND: Perioperative mortality rates in elderly patients undergoing emergent general/vascular operations are high and vary widely across Michigan hospitals.

METHODS: We identified 23,224 patients undergoing emergent general/vascular surgical procedures at 41 hospitals within the Michigan Surgical Quality Collaborative between 2006 and 2011. Hospitals were ranked by risk- and reliability-adjusted 30-day mortality rates and grouped into tertiles. We stratified patients by age (<75 and ≥75 years). Risk-adjusted major complication and failure-to-rescue (ie, mortality after major complication) rates were determined for each tertile of hospital mortality.

RESULTS: Risk-adjusted mortality rates in elderly patients varied 2-fold across all hospitals. Complication rates correlated poorly with mortality. Failure-to-rescue rates, however, were markedly higher in high-mortality hospitals (29% lowest tertile vs 41% highest tertile; P < 0.01). When compared with younger patients, overall failure-to-rescue rates were almost 2-fold greater in the elderly (36.1% ≥75 vs 18.7% <75; P < 0.01).

CONCLUSIONS: A hospital's failure to rescue patients from major complications seems to underlie the variation in mortality rates across Michigan hospitals after emergent surgery. Although higher failure-to-rescue rates in the elderly may signify their diminished physiological reserve for surviving critical illness, the wide variation across hospitals also highlights the importance of systems aimed at the early recognition and effective management of major complications in this vulnerable population.

Author List

Sheetz KH, Waits SA, Krell RW, Campbell DA Jr, Englesbe MJ, Ghaferi AA

Author

Amir Ghaferi MD President, Phys Enterprise & SAD Clinical Affairs in the Medical College Physicians Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Cohort Studies
Emergencies
Female
Hospital Mortality
Humans
Male
Michigan
Middle Aged
Postoperative Care
Postoperative Complications
Quality Assurance, Health Care
Quality Improvement
Registries
Retrospective Studies
Surgical Procedures, Operative
Vascular Surgical Procedures