Abdominal surgical trajectories associated with failure to rescue. A nationwide analysis

Abstract

Background The ability to detect and treat complications of surgery early is essential for optimal patient outcomes. The FTR rate is defined as death among patients who develop at least one complication after the surgical procedure, and may be used to monitor a hospital’s quality of surgical care. The aim of this observational study was to explore FTR in Norway and to see if we could identify surgical trajectories associated with high FTR. Methods Data on all abdominal surgeries in Norwegian hospitals from 2011–2017 were obtained from the Norwegian Patient Registry and linked with the national population register. Surgical and other postoperative complication rates and FTR within 30 days (deaths occurring in and out of hospital) were assessed. We identified surgical trajectories (type of procedures—type of complication—dead/alive at 30 days after operation) associated with the highest volume of deaths (FTR-V) and highest risk of death (FTR-R) after a postoperative complication. Results Of the total 626 052 primary abdominal procedures, 224 871 (35.8%) had at least one complication, this includes 83 037 patients. The most common postoperative complications were sepsis (N = 14 331) and respiratory failure (N = 7 970). The high-volume trajectories (FTR-V) were endoscopic retrograde cholangiopancreatography (ERCP)—sepsis—death (N = 294, 13.8%); open colon resections—sepsis—death (N = 279, 28.1%); and procedures with stoma formation—sepsis—death (N = 272, 27%). Similarly, patients operated with embolectomy of the visceral arteries and experiencing post-operative sepsis were associated with an extremely high risk of 30-day FTR of 81.5%. In, general a FTR patient had higher mean age, increased rate of emergency surgery and more comorbidity. Hospital size were not associated with FTR. Conclusion At a national level, there exists high volume and risk surgical trajectories associated with failure to rescue. These trajectories represent major targets for quality improvement initiatives.

Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study

“…We have shown that Norwegian hospitals varied in readmission rate, 30-day mortality and length of stay 12. Specific procedures are associated with high-risk and high-volume FTR trajectories, indicating national variability in FTR 13. Nevertheless, knowledge gaps exist.…”

“…12 Specific procedures are associated with high-risk and high-volume FTR trajectories, indicating national variability in FTR. 13 Nevertheless, knowledge gaps exist. Most FTR evidence comes from the USA, where healthcare has a different structure than in Europe.…”