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

T. Ahmad; R. A. Bouwman; I. Grigoras; C. Aldecoa; C. Hofer; A. Hoeft; P. Holt; L. A. Fleisher; W. Buhre; R. M. Pearse; Marissa Ferguson; Michael MacMahon; Mark Shulman; Ritchie Cherian; Helen Currow; Kathirgamanathan Kanathiban; David Gillespie; Edward Pathmanathan; Katherine Phillips; Jenifer Reynolds; Joanne Rowley; Jeanene Douglas; Ross Kerridge; Sameer Garg; Michael Bennett; Megha Jain; David Alcock; Nico Terblanche; Rochelle Cotter; Kate Leslie; Marcelle Stewart; Nicolette Zingerle; Antony Clyde; Oliver Hambidge; Adam Rehak; Sharon Cotterell; Wilson Binh Quan Huynh; Timothy McCulloch; Erez Ben-Menachem; Thomas Egan; Jennifer Cope; Richard Halliwell; Paul Fellinger; Markus Haisjackl; Simone Haselberger; Caroline Holaubek; Paul Lichtenegger; Florian Scherz; Werner Schmid; Franz Hoffer; Veronika Cakova; Andreas Eichwalder; Norbert Fischbach; Reinhold Klug; Elisabeth Schneider; Martin Vesely; Reinhart Wickenhauser; Karl Gernot Grubmueller; Marion Leitgeb; Friedrich Lang; Nancy Toro; Marlene Bauer; Friedrich Laengle; Claudia Haberl; Thomas Mayrhofer; Christoph Trybus; Christian Buerkle; Karin Forstner; Reinhard Germann; Harald Rinoesl; Elke Schindler; Ernst Trampitsch; Gerhard Bogner; Daniel Dankl; Martin Duenser; Gerhard Fritsch; Ilse Gradwohl-Matis; Andreas Hartmann; Thomas Hoelzenbein; Tarkan Jaeger; Franz Landauer; Gregor Lindl; Michael Lux; Johannes Steindl; Ottokar Stundner; Christian Szabo; Jawad Bidgoli; Hans Verdoodt; Patrice Forget; David Kahn; Fernande Lois; Mona Momeni; Caroline Pregardien; Audrey Pospiech; Arnaud Steyaert; Laurent Veevaete; Dirk De Kegel; Karen De Jongh; Luc Foubert; Carine Smitz; International Surgical Outcomes Study (ISOS) group; Olusola A Idowu

doi:10.1093/bja/aex185

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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

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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

T. Ahmad, R. A. Bouwman, I. Grigoras, C. Aldecoa, C. Hofer, A. Hoeft, P. Holt, L. A. Fleisher, W. Buhre, R. M. Pearse, …

British journal of anaesthesia : BJA, Vol.119(2), pp.258-266

08/01/2017

DOI: 10.1093/bja/aex185

PMID: 28854536

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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 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.

Anesthesiology

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Title: Subtitle: 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
Creators: T. Ahmad - Queen Mary University of London
R. A. Bouwman - Catharina Ziekenhuis
I. Grigoras - Grigore T. Popa University of Medicine and Pharmacy
C. Aldecoa - Hospital Universitario Río Hortega
C. Hofer - Triemli Hospital
A. Hoeft - University Hospital Bonn
P. Holt - St George's, University of London
L. A. Fleisher - University of Pennsylvania
W. Buhre - Maastricht University Medical Centre
R. M. Pearse - Queen Mary University of London
Marissa Ferguson - The Alfred Hospital
Michael MacMahon - The Alfred Hospital
Mark Shulman - The Alfred Hospital
Ritchie Cherian - Blacktown Hosp, Blacktown, NSW, Australia
Helen Currow - Blacktown Hosp, Blacktown, NSW, Australia
Kathirgamanathan Kanathiban - Blacktown Hosp, Blacktown, NSW, Australia
David Gillespie - Coffs Harbour Base Hosp, Coffs Harbour, NSW, Australia
Edward Pathmanathan - Coffs Harbour Base Hosp, Coffs Harbour, NSW, Australia
Katherine Phillips - Coffs Harbour Base Hosp, Coffs Harbour, NSW, Australia
Jenifer Reynolds - Coffs Harbour Base Hosp, Coffs Harbour, NSW, Australia
Joanne Rowley - Coffs Harbour Base Hosp, Coffs Harbour, NSW, Australia
Jeanene Douglas - John Hunter Hospital
Ross Kerridge - John Hunter Hospital
Sameer Garg - Mount Druitt Hosp, Blacktown, NSW, Australia
Michael Bennett - Prince Wales Hosp, Randwick, NSW, Australia
Megha Jain - Prince Wales Hosp, Randwick, NSW, Australia
David Alcock - Royal Hobart Hosp, Hobart, Tas, Australia
Nico Terblanche - Royal Hobart Hosp, Hobart, Tas, Australia
Rochelle Cotter - Royal Melbourne Hosp, Melbourne, Vic, Australia
Kate Leslie - Royal Melbourne Hosp, Melbourne, Vic, Australia
Marcelle Stewart - Royal Melbourne Hosp, Melbourne, Vic, Australia
Nicolette Zingerle - Royal Melbourne Hosp, Melbourne, Vic, Australia
Antony Clyde - Royal North Shore Hosp, St Leonards, NSW, Australia
Oliver Hambidge - Royal North Shore Hosp, St Leonards, NSW, Australia
Adam Rehak - Royal North Shore Hosp, St Leonards, NSW, Australia
Sharon Cotterell - The Alfred Hospital
Wilson Binh Quan Huynh - The Alfred Hospital
Timothy McCulloch - The Alfred Hospital
Erez Ben-Menachem - St Vincents Hosp, Melbourne, Vic, Australia
Thomas Egan - St Vincents Hosp, Melbourne, Vic, Australia
Jennifer Cope - Westmead Hosp, Westmead, NSW, Australia
Richard Halliwell - Westmead Hosp, Westmead, NSW, Australia
Paul Fellinger - Allgemeines Krankenhaus Wien, Vienna, Austria
Markus Haisjackl - Allgemeines Krankenhaus Wien, Vienna, Austria
Simone Haselberger - Allgemeines Krankenhaus Wien, Vienna, Austria
Caroline Holaubek - Allgemeines Krankenhaus Wien, Vienna, Austria
Paul Lichtenegger - Allgemeines Krankenhaus Wien, Vienna, Austria
Florian Scherz - Allgemeines Krankenhaus Wien, Vienna, Austria
Werner Schmid - Allgemeines Krankenhaus Wien, Vienna, Austria
Franz Hoffer - Landesklinikum Hollabrunn, Hollabrun, Austria
Veronika Cakova - Landesklinikum Horn, Horn, Austria
Andreas Eichwalder - Landesklinikum Horn, Horn, Austria
Norbert Fischbach - Landesklinikum Horn, Horn, Austria
Reinhold Klug - Landesklinikum Horn, Horn, Austria
Elisabeth Schneider - Landesklinikum Horn, Horn, Austria
Martin Vesely - Landesklinikum Horn, Horn, Austria
Reinhart Wickenhauser - Landesklinikum Horn, Horn, Austria
Karl Gernot Grubmueller - Landesklinikum Krems, Krems, Austria
Marion Leitgeb - Landesklinikum Krems, Krems, Austria
Friedrich Lang - Landesklinikum Neunkirchen, Neunkirchen, Austria
Nancy Toro - Landesklinikum Neunkirchen, Neunkirchen, Austria
Marlene Bauer - Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
Friedrich Laengle - Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
Claudia Haberl - Landesklinikum Zwettl, Zwettl, Austria
Thomas Mayrhofer - Landesklinikum Zwettl, Zwettl, Austria
Christoph Trybus - Landesklinikum Zwettl, Zwettl, Austria
Christian Buerkle - Landeskrankenhaus Feldkirch
Karin Forstner - Landeskrankenhaus Feldkirch
Reinhard Germann - Landeskrankenhaus Feldkirch
Harald Rinoesl - Landeskrankenhaus Feldkirch
Elke Schindler - Landeskrankenhaus Villach, Villach, Austria
Ernst Trampitsch - Landeskrankenhaus Villach, Villach, Austria
Gerhard Bogner - Salzburger Landeskliniken
Daniel Dankl - Salzburger Landeskliniken
Martin Duenser - Salzburger Landeskliniken
Gerhard Fritsch - Salzburger Landeskliniken
Ilse Gradwohl-Matis - Salzburger Landeskliniken
Andreas Hartmann - Salzburger Landeskliniken
Thomas Hoelzenbein - Salzburger Landeskliniken
Tarkan Jaeger - Salzburger Landeskliniken
Franz Landauer - Salzburger Landeskliniken
Gregor Lindl - Salzburger Landeskliniken
Michael Lux - Salzburger Landeskliniken
Johannes Steindl - Salzburger Landeskliniken
Ottokar Stundner - Salzburger Landeskliniken
Christian Szabo - Ctr Hosp Reg Namur, Namur, Belgium
Jawad Bidgoli - Ctr Hosp Univ Brugmann, Brussels, Belgium
Hans Verdoodt - Ctr Hosp Univ Brugmann, Brussels, Belgium
Patrice Forget - Clin Univ St Luc, Brussels, Belgium
David Kahn - Clin Univ St Luc, Brussels, Belgium
Fernande Lois - Clin Univ St Luc, Brussels, Belgium
Mona Momeni - Clin Univ St Luc, Brussels, Belgium
Caroline Pregardien - Clin Univ St Luc, Brussels, Belgium
Audrey Pospiech - Clin Univ St Luc, Brussels, Belgium
Arnaud Steyaert - Clin Univ St Luc, Brussels, Belgium
Laurent Veevaete - Clin Univ St Luc, Brussels, Belgium
Dirk De Kegel - Heilig Hart Ziekenhuis Roeselaere, Roeselare, Belgium
Karen De Jongh - Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium
Luc Foubert - Onze Lieve Vrouw Ziekenhuis Aalst, Aalst, Belgium
Carine Smitz - Univ Ziekenhuis Antwerpen, Antwerp, Belgium
International Surgical Outcomes Study (ISOS) group
Olusola A Idowu (Contributor) - University College Hospital, Ibadan
Resource Type: Journal article
Publication Details: British journal of anaesthesia : BJA, Vol.119(2), pp.258-266
Publisher: Elsevier
DOI: 10.1093/bja/aex185
PMID: 28854536
ISSN: 0007-0912
eISSN: 1471-6771
Number of pages: 9
Grant note: Nestle Health Sciences; Nestle SA Queen Mary University of London RP_2014-04-022 / National Institute for Health Research; National Institutes of Health Research (NIHR) National Institute for Health Research (UK); National Institutes of Health Research (NIHR)
Language: English
Date published: 08/01/2017
Academic Unit: Anesthesia
Record Identifier: 9984787457402771

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