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Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries
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- British journal of anaesthesia, 119(2), 258-266. Oxford University Press, BASE-Bielefeld Academic Search Engine, Ahmad, T, Bouwman, R A, Grigoras, I, Aldecoa, C, Hofer, C, Hoeft, A, Holt, P, Fleisher, L A, Buhre, W, Pearse, R M & International Surgical Outcomes Study 2017, ' 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 ', British Journal of Anaesthesia, vol. 119, no. 2, pp. 258-266 . https://doi.org/10.1093/bja/aex185, British Journal of Anaesthesia, 119(2), 258-266. ELSEVIER SCI LTD, Ahmad, T, Bouwman, R A, Grigoras, I, Aldecoa, C, Hofer, C, Hoeft, A, Holt, P, Fleisher, L A, Buhre, W, Pearse, R M, Ferguson, M, MacMahon, M, Shulman, M, Cherian, R, Currow, H, Kanathiban, K, Gillespie, D, Pathmanathan, E, Phillips, K, Reynolds, J, Rowley, J, Douglas, J, Kerridge, R, Garg, S, Bennett, M, Jain, M, Alcock, D, Terblanche, N, Cotter, R, Leslie, K, Stewart, M, Zingerle, N, Clyde, A, Hambidge, O, Rehak, A, Cotterell, S, Huynh, W B Q, McCulloch, T, Ben-Menachem, E, Egan, T, Cope, J, Halliwell, R, Fellinger, P, Haisjackl, M, Haselberger, S, Holaubek, C, Lichtenegger, P, Scherz, F, Schmid, W, Hoffer, F, Cakova, V, Eichwalder, A, Fischbach, N, Klug, R, Schneider, E, Vesely, M, Wickenhauser, R, Grubmueller, K G, Leitgeb, M, Lang, F, Toro, N, Bauer, M, Laengle, F, Haberl, C, Mayrhofer, T, Trybus, C, Buerkle, C, Forstner, K, Germann, R, Rinoesl, H, Schindler, E, Trampitsch, E, Bogner, G, Dankl, D, Duenser, M, Fritsch, G, Gradwohl-Matis, I, Hartmann, A, Hoelzenbein, T, Jaeger, T, Landauer, F, Lindl, G, Lux, M, Steindl, J, Stundner, O, Szabo, C, Bidgoli, J, Verdoodt, H, Forget, P, Kahn, D, Lois, F, Momeni, M, Pregardien, C, Pospiech, A, Steyaert, A, Veevaete, L, De Kegel, D, De Jongh, K, Foubert, L, Smitz, C, Vercauteren, M, Poelaert, J, Van Mossevelde, V, Abeloos, J, Bouchez, S, Coppens, M, De Baerdemaeker, L, Deblaere, I, De Bruyne, A, De Hert, S, Fonck, K, Heyse, B, Jacobs, T, Lapage, K, Moerman, A, Neckebroek, M, Parashchanka, A, Roels, N, Van Den Eynde, N, Vandenheuvel, M, Van Limmen, J, Vanluchene, A, Vanpeteghem, C, Wouters, P, Wyffels, P, Huygens, C, Vandenbempt, P, Van de Velde, M, Dylst, D, Janssen, B, Schreurs, E, Aleixo, F B, Candido, K, Batista, H D, Guimaraes, M, Guizeline, J, Hoffmann, J, Lobo, S, Marques Lobo, F R, Nascimento, V, Nishiyama, K, Pazetto, L, Souza, D, Rodrigues, R S, Vilela dos Santos, A M, Jardim, J, Sa Malbouisson, L M, Silva, J, do Nascimento Junior, P, Baio, T H, Pereira de Castro, G I, Watanabe 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Oxford University Press
- Publication Year :
- 2017
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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.
- Subjects :
- operative
Male
Pediatrics
GLOBAL HEALTH
Cohort Studies
0302 clinical medicine
Postoperative Complications
030202 anesthesiology
surgical procedures, operative, mortality
Health care
statistics and numerical data
030212 general & internal medicine
Hospital Mortality
Prospective Studies
Prospective cohort study
Aged, 80 and over
HIGH-RISK SURGERY
COMPLICATIONS
OUTCOMES
Incidence (epidemiology)
Middle Aged
PATIENT MORTALITY
Female
SURGICAL MORTALITY
Cohort study
Adult
medicine.medical_specialty
methods
03 medical and health sciences
Anesthesiology
medicine
QUALITY
Humans
Elective surgery
postoperative care, statistics and numerical data
Aged
Quality of Health Care
Postoperative Care
business.industry
Postoperative complication
mortality
CANCER-SURGERY
surgical procedures
Anesthesiology and Pain Medicine
Logistic Models
VOLUME
postoperative care, methods
Human medicine
Complication
business
Subjects
Details
- Language :
- English
- ISSN :
- 00070912
- Volume :
- 119
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- British Journal of Anaesthesia
- Accession number :
- edsair.doi.dedup.....a5bae08c5962467cc01ffeb3bd4d4d61
- Full Text :
- https://doi.org/10.1093/bja/aex185