title: Association of Medical Comorbidities, Surgical Outcomes, and Failure to Rescue: An Analysis of the Rhode Island Hospital NSQIP Database.
abstract: BACKGROUND
  Failure to rescue (FTR) is a key metric of perioperative morbidity and mortality. We review perioperative medical comorbidities (MCMs) to determine what factors are associated with complications and rates of FTR.
  
  
  METHODS
  A retrospective review of a NSQIP database including general, vascular, and surgical subspecialty patients from a tertiary referral center between March 2008 and March 2013 was performed. Demographics, MCMs, complications, 30-day mortality, and risk of FTR associated with specific complications and MCM were evaluated.
  
  
  RESULTS
  A total of 7,763 patients were included; 52.6% had MCMs and 14% (n = 1,099) experienced a complication. Patients with complications were older (64.9 vs 55 years; p < 0.001), more likely male (54% vs 44%; p < 0.001), and had more MCMs per patient (1.6 vs 1.4; p < 0.001). Complications were also associated with renal failure (odds ratio [OR] = 1.4; 95% CI, 1.0-2.0), steroid use (OR = 1.9; 95% CI, 1.4-2.5), CHF (OR = 2.5; 95% CI, 1.2-5.1), and ascites (OR = 9.1; 95% CI, 3.7-21.7), but not diabetes, hypertension, or COPD. There were 117 (11%) deaths among patients with complications. Adjusting for age, sex, American Society of Anesthesiologists class, and number of comorbidities, FTR was associated with postoperative respiratory failure, sepsis, and renal failure, as well as comorbid CHF, renal failure, ascites, and disseminated cancer.
  
  
  CONCLUSIONS
  Specific comorbidities are associated with higher rates of complications and FTR. Preoperative CHF, renal failure, and ascites, which were associated with FTR, can reflect a physiologic inability to tolerate complication-induced fluid shifts. Postoperative mortality was associated with signs of end organ damage, including sepsis, respiratory failure, and renal failure. Earlier recognition of these complications in at-risk patients should improve rates of FTR.
authors.affiliation: Department of Surgery, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: Larissa C
authors.initials: LC
authors.lastname: Chiulli
authors.affiliation: Department of Surgery, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Stephen
authors.affiliation: Department of Surgery, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI.
authors.forename: Daithi S
authors.initials: DS
authors.lastname: Heffernan
authors.affiliation: Department of Surgery, Alpert Medical School, Brown University, Rhode Island Hospital, Providence, RI. Electronic address: tminer@lifespan.org.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Miner
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D012237:Rhode Island; D012307:Risk Factors