title: Analyzing "failure to rescue": is this an opportunity for outcome improvement in cardiac surgery?
abstract: BACKGROUND
  In the setting of a statewide quality collaborative approach to the review of cardiac surgical mortalities in intensive care units (ICUs), variations in complication-related outcomes became apparent. Utilizing "failure to rescue" methodology (FTR; the probability of death after a complication), we compared FTR rates after adult cardiac surgery in low, medium, and high mortality centers from a voluntary, 33-center quality collaborative.
  
  
  METHODS
  We identified 45,904 patients with a Society of Thoracic Surgeons predicted risk of mortality who underwent cardiac surgery between 2006 and 2010. The 33 centers were ranked according to observed-to-expected ratios for mortality and were categorized into 3 equal groups. We then compared rates of complications and FTR.
  
  
  RESULTS
  Overall unadjusted mortality was 2.6%, ranging from 1.5% in the low-mortality group to 3.6% in the high group. The rate of 17 complications ranged from 19.1% in the low group to 22.9% in the high group while FTR rates were 6.6% in the low group, 10.4% in the medium group, and 13.5% in the high group (p < 0.001). The FTR rate was significantly better in the low mortality group for the majority of complications (11 of 17) with the most significant findings for cardiac arrest, dialysis, prolonged ventilation, and pneumonia.
  
  
  CONCLUSIONS
  Low mortality hospitals have superior ability to rescue patients from complications after cardiac surgery procedures. Outcomes review incorporating a collaborative multi-hospital approach can provide an ideal opportunity to review processes that anticipate and manage complications in the ICU and help recognize and share "differentiators" in care.
authors: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors: Haritha G
authors: HG
authors: Reddy
authors: Terry
authors: T
authors: Shih
authors: Michael J
authors: MJ
authors: Englesbe
authors: Francis L
authors: FL
authors: Shannon
authors: Patricia F
authors: PF
authors: Theurer
authors: Morley A
authors: MA
authors: Herbert
authors: Gaetano
authors: G
authors: Paone
authors: Gail F
authors: GF
authors: Bell
authors: Richard L
authors: RL
authors: Prager
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality*; D002423:Cause of Death; D005069:Evaluation Studies as Topic; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D058996:Quality Improvement; D018570:Risk Assessment; D062606:Tertiary Care Centers; D017211:Treatment Failure; D014481:United States
references: Ann Thorac Surg. 2009 Jul;88(1 Suppl):S2-22
references: 19559822
references: JAMA. 2002 Nov 6;288(17):2151-62
references: 12413375
references: J Am Coll Surg. 2010 Sep;211(3):325-30
references: 20800188
references: Ann Thorac Surg. 2012 Jan;93(1):36-43; discussion 43
references: 21975082
references: N Engl J Med. 2009 Oct 1;361(14):1368-75
references: 19797283
references: Ann Surg. 2011 Apr;253(4):811-6
references: 21475024
references: Ann Thorac Surg. 2007 Apr;83(4 Suppl):S3-12
references: 17383407
references: Anesthesiology. 2011 Aug;115(2):421-31
references: 21587063
references: Ann Thorac Surg. 2007 Apr;83(4 Suppl):S13-26
references: 17383406
references: Med Care. 1992 Jul;30(7):615-29
references: 1614231
references: Health Aff (Millwood). 2009 Jul-Aug;28(4):1189-98
references: 19597221
references: Ann Surg. 2009 Dec;250(6):1029-34
references: 19953723
references: Ann Thorac Surg. 2009 Jul;88(1 Suppl):S43-62
references: 19559824
references: Ann Thorac Surg. 2009 Jul;88(1 Suppl):S23-42
references: 19559823
references: JAMA. 2002 Oct 23-30;288(16):1987-93
references: 12387650
references: Ann Thorac Surg. 2012 Aug;94(2):573-9; discussion 579-80
references: 22633496
references: Semin Thorac Cardiovasc Surg. 2009 Spring;21(1):20-7
references: 19632559