title: Factors associated with failure-to-rescue in patients undergoing trauma laparotomy.
abstract: BACKGROUND
  Quality improvement initiatives have focused primarily on preventing in-hospital complications. Patients developing complications are at a greater risk of mortality; however, factors associated with failure-to-rescue (death after major complication) in trauma patients remain undefined. The aim of this study was to identify risk factors associated with failure-to-rescue in patients undergoing trauma laparotomy.
  
  
  METHODS
  An -8-year, retrospective analysis of patients undergoing trauma laparotomy was performed. Patients who developed major in-hospital complications were included. Major complications were defined as respiratory, infectious, cardiac, renal, or development of compartment syndrome. Regression analysis was performed to identify independent factors associated with failure-to-rescue after we adjusted for demographics, mechanism of injury, abdominal abbreviated injury scale, initial vital signs, damage control laparotomy, and volume of crystalloids and blood products administered.
  
  
  RESULTS
  A total of 1,029 patients were reviewed, of which 21% (n = 217) patients who developed major complications were included. The mean age was 39 ± 18 years, 82% were male, 61% had blunt trauma, and median abdominal abbreviated injury scale was 25 [16-34, interquartile range]. Respiratory complications (n = 77) followed by infectious complications (n = 75) were the most common complications. The failure-to-rescue rate was 15.7% (n = 34/217). Age, blunt trauma, severe head injury, uninsured status, and blood products administered on the second day were independent predictor for failure-to-rescue.
  
  
  CONCLUSIONS
  When major complications develop, age, uninsured status, severity of head injury, and prolonged resuscitation are associated independently with failure-to-rescue, whereas initial resuscitation, coagulopathy, and acidosis did not predict failure to rescue. Quality-of-care programs focus in patient level should be on improving the patient's insurance status, preventing secondary brain injury, and further development of resuscitation guidelines.
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ. Electronic address: bjoseph@surgery.arizona.edu.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Bardiya
authors.initials: B
authors.lastname: Zangbar
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Mazhar
authors.initials: M
authors.lastname: Khalil
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Ansab A
authors.initials: AA
authors.lastname: Haider
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Gary
authors.initials: G
authors.lastname: Vercruysse
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.affiliation: Division of Trauma, Department of Surgery, University of Arizona, Tucson, AZ.
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality / Q000628:therapy; D059325:Intra-Abdominal Hypertension / Q000209:etiology / Q000401:mortality / Q000628:therapy; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D051437:Renal Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012151:Resuscitation; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure