title: Failure to rescue and pulmonary resection for lung cancer.
abstract: OBJECTIVE
  Failure to rescue is defined as death after an acute inpatient event and has been observed among hospitals that perform general, vascular, and cardiac surgery. This study aims to evaluate variation in complication and failure to rescue rates among hospitals that perform pulmonary resection for lung cancer.
  
  
  METHODS
  By using the Society of Thoracic Surgeons General Thoracic Surgery Database, a retrospective, multicenter cohort study was performed of adult patients with lung cancer who underwent pulmonary resection. Hospitals participating in the Society of Thoracic Surgeons General Thoracic Surgery Database were ranked by their risk-adjusted, standardized mortality ratio (using random effects logistic regression) and grouped into quintiles. Complication and failure to rescue rates were evaluated across 5 groups (very low, low, medium, high, and very high mortality hospitals).
  
  
  RESULTS
  Between 2009 and 2012, there were 30,000 patients cared for at 208 institutions participating in the Society of Thoracic Surgeons General Thoracic Surgery Database (median age, 68 years; 53% were women, 87% were white, 71% underwent lobectomy, 65% had stage I). Mortality rates varied over 4-fold across hospitals (3.2% vs 0.7%). Complication rates occurred more frequently at hospitals with higher mortality (42% vs 34%, P < .001). However, the magnitude of variation (22%) in complication rates dwarfed the 4-fold magnitude of variation in failure to rescue rates (6.8% vs 1.7%, P < .001) across hospitals.
  
  
  CONCLUSIONS
  Variation in hospital mortality seems to be more strongly related to rescuing patients from complications than to the occurrence of complications. This observation is significant because it redirects quality improvement and health policy initiatives to more closely examine and support system-level changes in care delivery that facilitate early detection and treatment of complications.
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash; Surgical Outcomes Research Center, University of Washington, Seattle, Wash. Electronic address: ffarjah@uw.edu.
authors: Farhood
authors: F
authors: Farjah
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors: Leah
authors: L
authors: Backhus
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors: Aaron
authors: A
authors: Cheng
authors: Duke Clinical Research Institute, Duke University, Durham, NC.
authors: Brian
authors: B
authors: Englum
authors: Duke Clinical Research Institute, Duke University, Durham, NC.
authors: Sunghee
authors: S
authors: Kim
authors: Duke Clinical Research Institute, Duke University, Durham, NC.
authors: Paramita
authors: P
authors: Saha-Chaudhuri
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors: Douglas E
authors: DE
authors: Wood
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors: Michael S
authors: MS
authors: Mulligan
authors: Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
authors: Thomas K
authors: TK
authors: Varghese
mesh_terms: D000368:Aged; D016208:Databases, Factual; D003695:Delivery of Health Care; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014481:United States / Q000453:epidemiology
keywords: epidemiology; health policy; lung cancer; outcomes research.; quality improvement