title: The Effect of Comprehensive Society of Thoracic Surgeons Quality Improvement on Outcomes and Failure to Rescue.
abstract: BACKGROUND
  The Society of Thoracic Surgeons (STS) quality benchmarks guide clinical outcome improvement in cardiac surgery. Failure to rescue (FTR) from postoperative morbidity is a proposed metric of program quality. We examined the effect of a quality improvement initiative guided by STS quality measures on outcomes and FTR.
  
  
  METHODS
  Prospectively collected STS data on 3,065 consecutive patients who underwent nonemergency cardiac operations at a single institution from January 1, 2010, to January 31, 2014, were retrospectively analyzed. On January 1, 2012, the quality improvement initiative was implemented. Clinical outcomes and FTR rates were compared between operations performed before (group A) and after (group B) implementation.
  
  
  RESULTS
  STS predicted preoperative mortality and composite of mortality plus morbidity were similar in group A and group B (2.9% ± 3.7% vs 3.1% ± 4.0%, p = 0.21; 17.8% ± 12.1% vs 18.3% ± 12.4%, p = 0.24, respectively). However, the observed mortality and composite mortality plus morbidity were lower in group B vs group A (31 of 1,576 [2.0%] vs 46 of 1,489 [3.1%], p = 0.05; 168 of 1,576 [10.7%] vs 301 of 1,489 [20.2%], p = 0.0001, respectively). Despite clinical outcome improvement, no differences in FTR rates were observed across all seven major morbidity indicators in group A vs B (35 of 290 [12.1%] vs 19 of 156 [12.1%], p = 1.00, respectively). The finding of similarity in the FTR rate remained consistent during procedural subgroup analysis for isolated coronary artery bypass grafting in group A vs B (22 of 174 [12.6%] vs 9 of 77 [11.7%], p = 1.00, respectively).
  
  
  CONCLUSIONS
  Implementation of quality improvement initiatives significantly improves outcomes without affecting FTR rates. Further study is needed to determine if FTR provides additive value to quality assessment over existing STS metrics.
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Danny
authors: D
authors: Chu
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Patrick
authors: P
authors: Chan
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Lawrence M
authors: LM
authors: Wei
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Chris C
authors: CC
authors: Cook
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Thomas G
authors: TG
authors: Gleason
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Victor O
authors: VO
authors: Morell
authors: Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: badhwarv@upmc.edu.
authors: Vinay
authors: V
authors: Badhwar
mesh_terms: D000328:Adult; D019985:Benchmarking; D006348:Cardiac Surgical Procedures; D016208:Databases, Factual; D000067248:Failure to Rescue, Health Care; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D058996:Quality Improvement; D012189:Retrospective Studies; D016896:Treatment Outcome