Number and Type of Complications Associated With Failure to Rescue in Trauma Patients

Abstract

Background: Failure to rescue (FTR) is becoming a ubiquitous metric of quality care. The aim of our study is to determine the type and number of complications associated with FTR after trauma. Methods: We reviewed the Trauma Quality Improvement Program including patients who developed complications after admission. Patients were divided as the following: "FTR" if the patient died or "rescued" if the patient did not die. Logistic regression was used to ascertain the effect of the type and number of complications on FTR. Results: A total of 25,754 patients were included with 972 identified as FTR. Logistic regression identified sepsis (odds ratio [OR] ¼ 6.61 [4.72-9.27]), pneumonia (OR ¼ 2.79 [2.15-3.64]), acute respiratory distress syndrome (OR ¼ 4.6 [3.17-6.69]), and cardiovascular complications (OR ¼ 24.22 [19.39-30.26]) as predictors of FTR. The odds ratio of FTR increased by 8.8 for every single increase in the number of complications. Conclusions: Specific types of complications increase the odds of FTR. The overall complication burden will also increase the odds of FTR linearly.

Failure To Rescue, What Can Be Done To Prevent It?

“…Hospital factors such as teaching status, high hospital technology, and increasing nurse-to-patient ratio and presence of an ICU larger than 20 beds influenced FTR rates, offering a survival advantage for patients undergoing major surgery [38]. Regarding trauma patients, bed size over 600 and teaching status, besides being a level 1 center, were independently associated with lower FTR rates [35]. In a study that analyzed FTR in a medical population after acute myocardial infarction, major teaching hospitals displayed 19% lower odds of FTR than non-teaching hospitals, and hospitals with a good nursing mix and staffing, cardiac technology and teaching status displayed 33% lower odds of FTR than hospitals without these characteristics4.…”

“…Despites an increase in the number of complications being related to a higher risk of FTR, the type of complication can also have an impact [31,[33][34][35]. In addition to age, Injury Severity Score, Charlson Comorbidity Index and number of complications, complications like sepsis, pneumonia, acute respiratory distress syndrome and cardiovascular complications independently increased the risk of FTR [35]. Moreover, the impact of having a respiratory and an infectious complication combined is synergistic [34].…”

“…Hospital volume was also associated as a factor that affects FTR rates in several articles [3,7,14,30,35,39]. In a study using data from 27 countries from patients undergoing surgery in low, middle and highincome countries, hospitals were ranked by volume of surgical procedures and by complication rates.…”

“…The traditional FTR metric only accounts for one complication, and if there are multiple occurrences, only the first is counted [8,34,50]. Yet, the risk of FTR increases in a stepwise fashion with the number of complications and besides, the traditional approach may miss differences in what followed the index complication and lead to death [31,[33][34][35]. Certain index complications have been shown to be related to an increased risk for particular secondary complications, as myocardial infarction followed by cardiac arrest, and there is significant variation between some index complications and the following secondary complications [3,34].…”

“…In a cohort of emergency general surgery, Hatchimonji et al found that among the patients who died with more than 1 complication, 82.5% had a respiratory and 77.5% had an infectious complication. Having increased attention to specific complications such as respiratory, infectious or cardiovascular complications may also be important, since these independently increase the risk for FTR [34,35].…”