TY - JOUR
T1 - Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries
T2 - A 7-day cohort study of elective surgery
AU - International Surgical Outcomes Study (ISOS) Group
AU - Ahmad, T.
AU - Bouwman, R. A.
AU - Grigoras, I.
AU - Aldecoa, C.
AU - Hofer, C.
AU - Hoeft, A.
AU - Holt, P.
AU - Buhre, W.
AU - Pearse, Rupert M.
AU - Clavien, Pierre Alain
AU - Demartines, Nicolas
AU - Grocott, Mike
AU - Haddow, James
AU - Holt, Peter
AU - Moreno, Rui
AU - Pritchard, Naomi
AU - Rhodes, Andrew
AU - Wilson, Matt
AU - Ahmed, Tahania
AU - Halliwell, Richard
AU - Shulman, Mark
AU - Myles, Paul
AU - Schmid, Werner
AU - Hiesmayr, Michael
AU - Wouters, Patrick
AU - De Hert, Stefan
AU - Lobo, Suzana
AU - Beattie, Scott
AU - Wijeysundera, Duminda
AU - Fang, Xiangming
AU - Rasmussen, Lars
AU - Futier, Emmanuel
AU - Biais, Matthieu
AU - Venara, Aurélien
AU - Slim, Karem
AU - Sander, Michael
AU - Koulenti, Despoina
AU - Arvaniti, Kostoula
AU - Chan, Mathew
AU - Kulkarni, Atul
AU - Chandra, Susilo
AU - Tantri, Aida
AU - Geddoa, Emad
AU - Abbas, Muntadhar
AU - Della Rocca, Giorgio
AU - Sivasakthi, Datin
AU - Mansor, Marzida
AU - Luna, Pastor
AU - Bouwman, Arthur
AU - Buhre, Wolfgang
N1 - Publisher Copyright:
© The Author 2017. Published by Oxford University Press.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - 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 threefold 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 failureto- 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.
AB - 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 threefold 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 failureto- 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.
KW - methods
KW - mortality
KW - operative
KW - postoperative care
KW - statistics and numerical data
KW - surgical procedures
UR - http://www.scopus.com/inward/record.url?scp=85027521715&partnerID=8YFLogxK
U2 - 10.1093/bja/aex185
DO - 10.1093/bja/aex185
M3 - Article
C2 - 28854536
AN - SCOPUS:85027521715
SN - 0007-0912
VL - 119
SP - 258
EP - 266
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 2
ER -