title: Improving the care of elderly adults undergoing surgery in Michigan.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  State-wide surgical collaborative in Michigan.
  
  
  METHODS
  Older adults undergoing major general or vascular surgery between 2006 and 2011 (N = 24,216).
  
  
  METHODS
  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%.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Academic Surgery Development Program, Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kyle H
authors.initials: KH
authors.lastname: Sheetz
authors.forename: Karen
authors.initials: K
authors.lastname: Guy
authors.forename: James H
authors.initials: JH
authors.lastname: Allison
authors.forename: Kara A
authors.initials: KA
authors.lastname: Barnhart
authors.forename: Scott R
authors.initials: SR
authors.lastname: Hawken
authors.forename: Emily L
authors.initials: EL
authors.lastname: Hayden
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Starr
authors.forename: Michael N
authors.initials: MN
authors.lastname: Terjimanian
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Mullard
authors.forename: Greta
authors.initials: G
authors.lastname: Krapohl
authors.forename: Amir A
authors.initials: AA
authors.lastname: Ghaferi
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000401:mortality*; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D014656:Vascular Surgical Procedures / Q000401:mortality
keywords: geriatric surgery; surgical quality assessment