Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009.
BACKGROUND
Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.


METHODS
We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics.


RESULTS
The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group.


CONCLUSIONS
The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities.
Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
Lixin
L
Ou
Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
Jack
J
Chen
Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
Hassan
H
Assareh
Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
Stephanie J
SJ
Hollis
Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
Ken
K
Hillman
Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia, Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia.
Arthas
A
Flabouris
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D061214:Patient Safety; D016012:Poisson Distribution; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012307:Risk Factors; D055815:Young Adult