Failure to rescue after major gynecologic surgery.
OBJECTIVE
There is growing recognition that, in addition to occurrence of perioperative complications, the treatment of patients with complications influences outcome. We examined complications, failure to rescue (death in patients with a complication), and mortality rates for women who underwent abdominal hysterectomy.


METHODS
Women who underwent abdominal hysterectomy from 1998-2010 and whose data were recorded in the Nationwide Inpatient Sample were identified. Hospitals were stratified based on risk-adjusted mortality rates into 5 quintiles, and rates of complications and failure to rescue were examined.


RESULTS
A total of 664,229 women who had been treated at 741 hospitals were identified. The overall mortality rate for the cohort was 0.17%. The risk-adjusted, hospital-level mortality rate ranged from 0-1.12%. The complication rate was 6.5% at the hospitals with the lowest mortality rates, 9.9% at the second quintile hospitals, 9.5% at both the third and fourth quintile hospitals, and 7.9% at the hospitals with the highest mortality rates. In contrast to complications, the failure-to-rescue rate increased with each successive risk-adjusted mortality quintile. The failure-to-rescue rate was 0% at the hospitals with the lowest mortality rates and increased with each successive quintile to 1.1%, 2.1%, 2.7%, and 4.4% in the hospitals with the highest mortality rates (P < .0001).


CONCLUSIONS
For women who underwent abdominal hysterectomy, hospital complication rates correlated poorly with mortality rates; failure-to-rescue is strongly associated with in-hospital mortality rates. The treatment of complications, not the actual development of a complication, is the most important factor to use to predict death after major gynecologic surgery.
Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, Columbia University, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, Columbia University, New York, NY. Electronic address: jw2459@columbia.edu.
Jason D
JD
Wright
Cande V
CV
Ananth
Laureen
L
Ojalvo
Thomas J
TJ
Herzog
Sharyn N
SN
Lewin
Yu-Shiang
YS
Lu
Alfred I
AI
Neugut
Dawn L
DL
Hershman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000401:mortality*; D007431:Intraoperative Complications / Q000401:mortality* / Q000628:therapy; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D016879:Salvage Therapy; D014481:United States
complications; failure to rescue; gynecology; hysterectomy; mortality rate