title: Failure-to-rescue and interprovider comparisons after elective abdominal aortic aneurysm repair.
abstract: BACKGROUND
  The use of postoperative complication rates to derive metrics such as failure-to-rescue (FTR) is of increasing interest in assessing the quality of care. The aim of this study was to quantify FTR rates for elective abdominal aortic aneurysm (AAA) repair in England using administrative data, and to examine its validity against case-note review.
  
  
  METHODS
  A retrospective observational study using Hospital Episode Statistics (HES) data was combined with a multicentre audit of data quality. All elective AAA repairs done in England between 2005 and 2010 were identified. Postoperative complications were extracted, FTR rates quantified, and differences in FTR and in-hospital death rates established. A multicentre case-note review was performed to establish the accuracy of coding of complications, and the impact of inaccuracies on FTR rates derived from HES data.
  
  
  RESULTS
  A total of 19 638 elective AAA repairs were identified from HES; the overall mortality rate was 4·6 per cent. Patients with complications (19·2 per cent) were more likely to die than those without complications (odds ratio 12·22, 95 per cent c.i. 10·51 to 14·21; P < 0·001) and had longer hospital stays (P < 0·001). FTR rates correlated strongly with death rates, whereas complication rates did not. On case-note review (661 procedures), 41·5 per cent of patients had a complication recorded in the case notes. There was evidence of systematic under-reporting of complications in HES, leading to an overall misclassification rate of 36·3 (95 per cent c.i. 33·7 to 39·2) per cent (P < 0·001), which was less pronounced for surgical complications (12·6 (11·1 to 13·9) per cent; P <0·001). Despite this, the majority of FTR rates derived from HES were not significantly different from those derived from case-note data.
  
  
  CONCLUSIONS
  Postoperative complication and FTR rates after elective AAA repair can be derived from HES data. However, use of the metric for interprovider comparisons should be done cautiously, and only with concurrent case-note validation given the degree of miscoding identified.
authors.affiliation: Department of Outcomes Research, St George's University of London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Sinha
authors.forename: B
authors.initials: B
authors.lastname: Ata Ozdemir
authors.forename: U
authors.initials: U
authors.lastname: Khalid
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: J D
authors.initials: JD
authors.lastname: Poloniecki
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: P J E
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000401:mortality / Q000592:standards*; D057510:Endovascular Procedures / Q000401:mortality / Q000592:standards; D004739:England / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D011787:Quality of Health Care / Q000592:standards; D012189:Retrospective Studies; D016896:Treatment Outcome