Adult: Perioperative Management
National trend in failure to rescue after cardiac surgeries

https://doi.org/10.1016/j.jtcvs.2022.02.037Get rights and content

Abstract

Objectives

Failure to rescue (FTR), defined as postoperative inpatient death after potentially treatable major complications, is a nationally endorsed quality of care measure, however, the effect of practice change on FTR is unknown. In this study, we aimed to define the FTR trend after cardiac surgery in the United States.

Methods

In this retrospective analysis of the National Inpatient Sample database we identified adult patients who underwent cardiac surgeries in the United States between 2000 and 2018, defined incidence and trends in FTR adjusted for sex, age, diagnosis-related group, and comorbidity. Trends were analyzed using Joinpoint (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute) regression software.

Results

The study included 6,185,032 hospitalizations for cardiac surgeries. Risk-adjusted FTR after deep venous thromboembolism/pulmonary embolism and sepsis has declined from 2000 to 2018 (annual percent change [APC] = −6.4% and −11.6%, respectively; P < .001). After pneumonia, FTR has increased significantly since 2011 (APC = 9.3%; P < .001). Since 2012, FTR due to gastrointestinal hemorrhage has increased substantially (APC = 15.9%; P < .001). The risk-adjusted FTR rate in patients 75 years of age or older significantly declined until 2011 (APC = −12.6%; P < .001) and became comparable with the FTR rate of younger patients by the end of the study.

Conclusions

There have been significant reductions in FTR in elderly patients and a reduction in postprocedural mortality associated with sepsis and venous thromboembolism overall after cardiac surgery. This might provide evidence supporting national targeted quality metrics and care bundles for complications such as pneumonia and gastrointestinal bleeding, which had an increasing FTR.

Section snippets

Data Source and Patient Population

The data for this study were extracted from the National Inpatient Sample (NIS) data set, which is a part of the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality (AHRQ). The NIS is the largest publicly available all-payer inpatient health care database in the United States. It contains data on approximately 8 million discharges each year. The sampling frame of NIS was changed in 2012. Before 2012 data were collected from more than 1000

Results

A total of 6,185,032 major cardiac surgeries were performed from 2000 through 2018. At least 1 serious treatable complication occurred after 274,791 surgeries (4.4%). In-hospital deaths due to postoperative complications were 33,170 (0.5% of total or 12.1% of surgeries with complications).

Discussion

Our study describes the FTR rate after cardiac surgeries on the national level and draws the pattern of how the FTR rate changed over the years using the NIS all-payer database. Administrative discharge databases are considered appropriate for assessing the quality or outcomes of care and examining the assessment of the effect of new health care policies, guidelines, or practices on the FTR rate.21 Thus, these databases are usually used to rank hospitals according to specialties.

We observed a

Conclusions

During the past 19 years, the risk of death after complications for older patients became comparable with mortality for younger patients. Despite progress in the treatment of complications and reduction of mortality after sepsis and DVT or PE, FTR rates are increasing in recent years, mainly because of the increase in failure rates after pneumonia and GI bleeding. Further studies are needed to determine the cause of these increased rates and to deliver targeted policy and practice changes to

References (39)

  • M. Riera et al.

    Mortality from postoperative complications (failure to rescue) after cardiac surgery in a university hospital [in Spanish]

    Rev Calid Asist

    (2016)
  • J.H. Silber et al.

    Hospital and patient characteristics associated with death after surgery

    Med Care

    (1992)
  • J.H. Silber et al.

    Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery

    JAMA

    (1995)
  • B.D. Lau et al.

    Venous thromboembolism quality measures fail to accurately measure quality

    Circulation

    (2018)
  • J.I. Portuondo et al.

    Failure to rescue as a surgical quality indicator: current concepts and future directions for improving surgical outcomes

    Anesthesiology

    (2019)
  • H. Dakour-Aridi et al.

    Assessment of failure to rescue after abdominal aortic aneurysm repair using the National Surgical Quality Improvement Program procedure-targeted data set

    J Vasc Surg

    (2018)
  • J. Needleman et al.

    Using present-on-admission coding to improve exclusion rules for quality metrics: the case of failure-to-rescue

    Med Care

    (2013)
  • A. Brunelli et al.

    Risk-adjusted morbidity, mortality and failure-to-rescue models for internal provider profiling after major lung resection

    Interact Cardiovasc Thorac Surg

    (2006)
  • R.D. Staiger et al.

    Can early postoperative complications predict high morbidity and decrease failure to rescue following major abdominal surgery?

    Ann Surg

    (2020)
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