Failure-to-Rescue After Colorectal Cancer Surgery and the Association with Three Structural Hospital Factors

Henneman, D.; Leersum, N.J. van; Berge, M. Ten; Snijders, H.S.; Fiocco, Marta; Wiggers, Theo; Tollenaar, Rob A.E.M.; Wouters, Michel W. J. M.

doi:10.1245/s10434-013-3037-z

Cited by 66 publications

(57 citation statements)

References 23 publications

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“…principal referral) had a higher FTR rate compared to other peer hospital groups (low volume hospitals). This is in contrast to the reports of an association between high patient volume and better FTR outcome [41]–[43], but supports the findings that the volume-outcome relationship may be confounded by many other factors such as the level of nurse staffing [44], patient insurance status [45], severity of illness [33], level of ICU [46], and overall staffing level of the hospital [47].…”

Section: Discussionsupporting

confidence: 80%

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

Chen

Assareh

et al. 2014

PLoS ONE

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BackgroundDespite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.MethodsWe conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics.ResultsThe average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group.ConclusionsThe decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities.

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Section: Discussionsupporting

confidence: 80%

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

Chen

Assareh

et al. 2014

PLoS ONE

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“…5-9 However, prior work is limited to single-center studies or those confined to specific patient populations. 10-12 These current studies fail to answer two important questions. First, it is unclear how hospital characteristics influence outcomes for patients undergoing different operations within the same center.…”

Section: Introductionmentioning

confidence: 64%

Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery

Sheetz

Dimick²,

Ghaferi³

2016

Annals of Surgery

167

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Objective To determine the effect of hospital characteristics on failure to rescue after high-risk surgery in Medicare Beneficiaries. Summary Background Data Reducing failure to rescue events is a common quality target for U.S. hospitals. Little is known about which hospital characteristics influence this phenomenon and more importantly by how much. Methods We identified 1,945,802 Medicare beneficiaries undergoing one of six high-risk general or vascular operations between 2007-10. Using multilevel mixed-effects logistic regression modeling, we evaluated how failure to rescue rates were influenced by specific hospital characteristics previously associated with postsurgical outcomes. We used variance partitioning to determine the relative influence of patient and hospital characteristics on the between-hospital variability in failure to rescue rates. Results Failure to rescue rates varied up to 11-fold between very high and very low mortality hospitals. Comparing the highest and lowest mortality hospitals, we observed that teaching status (range: OR 1.08-1.54), high hospital technology (range: OR 1.08-1.58), increasing nurse-to-patient ratio (range: OR 1.02-1.14), and presence of >20 ICU beds (range: OR 1.09-1.62) significantly influenced failure to rescue rates for all procedures. When taken together, hospital and patient characteristics accounted for 12% (lower extremity revascularization) to 57% (esophagectomy) of the observed variation in failure to rescue rates across hospitals. Conclusions While several hospital characteristics are associated with lower failure to rescue rates, these macro-system factors explain a small proportion of the variability between hospitals. This suggests that micro-system characteristics, such as hospital culture and safety climate, may play a larger role in improving a hospital's ability to manage postoperative complications.

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“…The first method divided complications into two groups as described earlier 19,20 : (1) mild complications, defined as any complication occurring within 30 days after resection and not being a severe complication and (2) severe complications, defined as a complication with serious consequences: leading to mortality, a reintervention (operative or percutaneous), or a postoperative hospital stay of at least 14 days. Any patient not having a mild or severe complication was analyzed as 'no complication'.…”

Section: Definitionsmentioning

confidence: 99%

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals

Govaert

Fiocco

Dijk³

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Failure-to-Rescue After Colorectal Cancer Surgery and the Association with Three Structural Hospital Factors

Cited by 66 publications

References 23 publications

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

Impact of Hospital Characteristics on Failure to Rescue Following Major Surgery

Costs of complications after colorectal cancer surgery in the Netherlands: Building the business case for hospitals

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