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Br J Anaesth. 2017 Aug 1;119(2):258-266. doi: 10.1093/bja/aex185.

Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery.

Author information

1
Queen Mary University of London, London EC1M 6BQ, UK.
2
Catharina Ziekenhuis, Eindhoven, The Netherlands.
3
Regional Institute of Oncology, 'Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania.
4
Hospital Universitario Rio Hortega, Valladolid, Spain.
5
Triemli City Hospital, Zurich, Switzerland.
6
University Hospital of Bonn, 53105, Bonn, Germany.
7
St Georges University of London, London SW17 0RE, UK.
8
University of Pennsylvania, Philadelphia, PA, USA.
9
Maastricht University Medical Centre, Maastricht, The Netherlands.
10
Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London EC1M 6BQ, UK.

Abstract

Background:

The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems.

Methods:

We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest).

Results:

A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a three-fold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failure-to-rescue, indicating differences between hospitals in the risk of death among patients after they develop complications.

Conclusions:

Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.

KEYWORDS:

methods; mortality; operative; postoperative care; statistics and numerical data; surgical procedures

PMID:
28854536
DOI:
10.1093/bja/aex185
[Indexed for MEDLINE]
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