November 23, 2009Annals of Surgery
Complications, Failure to Rescue, and Mortality With Major Inpatient Surgery in Medicare Patients
Key result
Treatment at high-mortality hospitals had a 2.5-fold higher mortality rate (8.0% vs 3.0%) driven by higher failure to rescue rates (16.7% vs 6.8%) rather than differences in complication rates.
Why the study?
Do differences in complication rates or failure to rescue rates explain hospital variations in surgical mortality among Medicare patients undergoing major surgery?
Population
Medicare beneficiaries undergoing 6 major operations in 2005 to 2006: pancreatectomy, esophagectomy…
Comparison
Treatment at the top 20% of hospitals ranked by… vs Treatment at the bottom 20% of hospitals ranked…
Design
Cohort
Authors
Discussion
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Implication
Failure to rescue was associated with surgical mortality variation; leaves open whether rescue-focused interventions improve outcomes.
Key Points
- This research aims to explore whether variations in surgical mortality rates are attributed to differences in complication rates or failure to rescue rates among hospitals.
- Studied Medicare beneficiaries undergoing 6 major operations from 2005 to 2006.
- Ranked hospitals by risk-adjusted mortality and divided them into top (best) and bottom (worst) 20%.
- Compared incidence of complications and failure to rescue rates between best and worst hospitals.
- Worst hospitals had mortality rates 2.5-fold higher than best hospitals (8.0% vs. 3.0%).
- Complication rates were similar in both groups (36.4% vs. 32.7%).
- Failure to rescue rates were significantly higher at worst hospitals (16.7% vs. 6.8%).
Study Design
Type
Observational
Multicenter
Yes
Structured PICO
Do differences in complication rates or failure to rescue rates explain hospital variations in surgical mortality among Medicare patients undergoing major surgery?
P
Population
Medicare beneficiaries undergoing 6 major operations in 2005 to 2006: pancreatectomy, esophagectomy, abdominal aortic aneurysm repair, coronary artery bypass grafting, aortic valve replacement, and mitral valve replacement
I
Intervention
Treatment at the top 20% of hospitals ('best') ranked by risk-adjusted mortality
C
Comparator
Treatment at the bottom 20% of hospitals ('worst') ranked by risk-adjusted mortality
O
Outcome
Mortality, complication rates, and failure to rescue rates (case-fatality rates in patients with a complication)hard clinical
Main Result
Absolute Event Rate: 8% vs 3%
Hospital variations in surgical mortality are primarily driven by differences in failure to rescue rates rather than the incidence of complications.
Cite This Study
Ghaferi et al. (2009) conducted an observational in Major inpatient surgery. Treatment at high-mortality ('worst') hospitals vs. Treatment at low-mortality ('best') hospitals was evaluated on Mortality rate. Treatment at high-mortality hospitals had a 2.5-fold higher mortality rate (8.0% vs 3.0%) driven by higher failure to rescue rates (16.7% vs 6.8%) rather than differences in complication rates.