Improving the Care of Elderly Adults Undergoing Surgery in Michigan

OBJECTIVES: To determine whether failure to rescue, as a driver of mortality, can be used to identify which hospitals attenuate the specific risks inherent to elderly adults undergoing surgery. DESIGN: Retrospective cohort study. SETTING: State-wide surgical collaborative in Michigan. PARTICIPANTS: Older adults undergoing major general or vascular surgery between 2006 and 2011 (N = 24,216). MEASUREMENTS: Thirty-four hospitals were ranked according to risk-adjusted 30-day mortality and grouped into tertiles. Within each tertile, rates of major complications and failure to rescue were calculated, stratifying outcomes according to age (<75 vs ≥ 75). Next, differences in failure-to-rescue rates between age groups within each hospital were calculated. RESULTS: Failure-to-rescue rates were more than two times as high in elderly adults as in younger individuals in each tertile of hospital mortality (26.0% vs 10.3% at high-mortality hospitals, P < .001). Within hospitals, the average difference in failure-to-rescue rates was 12.5%. Nine centers performed better than expected, and three performed worse than expected, with the largest differences exceeding 25%. CONCLUSION: Although elderly adults experience higher failure-to-rescue rates, this does not account for hospitals' overall capacity to rescue individuals from complications. Comparing rates of younger and elderly adults within hospitals may identify centers where efforts toward complication rescue favor, or are customized for, elderly adults. These centers should be studied as part of the collaborative's effort to address the disparate outcomes that elderly adults in Michigan experience.