title: Failure to Rescue Rates After Coronary Artery Bypass Grafting: An Analysis From The Society of Thoracic Surgeons Adult Cardiac Surgery Database.
abstract: BACKGROUND
  Failure to rescue (FTR) is increasingly recognized as an important quality indicator in surgery. The Society of Thoracic Surgeons National Database was used to develop FTR metrics and a predictive FTR model for coronary artery bypass grafting (CABG).
  
  
  METHODS
  The study included 604,154 patients undergoing isolated CABG at 1,105 centers from January 2010 to January 2014. FTR was defined as death after four complications: stroke, renal failure, reoperation, and prolonged ventilation. FTR was determined for each complication and a composite of the four complications. A statistical model to predict FTR was developed.
  
  
  RESULTS
  FTR rates were 22.3% for renal failure, 16.4% for stroke, 12.4% for reoperation, 12.1% for prolonged ventilation, and 10.5% for the composite. Mortality increased with multiple complications and with specific combinations of complications. The multivariate risk model for prediction of FTR demonstrated a C index of 0.792 and was well calibrated, with a 1.0% average difference between observed/expected (O/E) FTR rates. With centers grouped into mortality terciles, complication rates increased modestly (11.4% to 15.7%), but FTR rates more than doubled (6.8% to 13.9%) from the lowest to highest terciles. Centers in the lowest complication rate tercile had an FTR O/E of 1.14, whereas centers in the highest complication rate tercile had an FTR O/E of 0.91.
  
  
  CONCLUSIONS
  CABG mortality rates vary directly with FTR, but complication rates have little relation to death. FTR rates derived from The Society of Thoracic Surgeons data can serve as national benchmarks. Predicted FTR rates may facilitate patient counseling, and FTR O/E ratios have promise as valuable quality metrics.
authors.affiliation: Department of Surgery, University of Florida, Jacksonville, Florida. Electronic address: fred.edwards@jax.ufl.edu.
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
authors.affiliation: Department of Surgery, University of Kentucky, Lexington, Kentucky.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferraris
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Kurlansky
authors.affiliation: Sanger Heart and Vascular Institute, Carolinas Healthcare System, Charlotte, North Carolina.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Xia
authors.initials: X
authors.lastname: He
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.affiliation: Starr-Wood Cardiac Group, Portland, Oregon.
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Furnary
authors.affiliation: Cardiothoracic Surgery Associates, Nashville, Tennessee.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.affiliation: Department of Surgery, Southern Illinois University, Springfield, Illinois.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
authors.affiliation: Section of Cardiac Surgery, University of Michigan, Rochester, Michigan.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Fazzalari
authors.affiliation: Department of Surgery, Baylor University Medical Center, Dallas, Texas.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Vinay
authors.initials: V
authors.lastname: Badhwar
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Ying
authors.initials: Y
authors.lastname: Xian
authors.affiliation: Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida.
authors.forename: Jeffrey P
authors.initials: JP
authors.lastname: Jacobs
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Moritz C
authors.initials: MC
authors.lastname: Wyler von Ballmoos
authors.affiliation: Department of Surgery/Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Shahian
mesh_terms: D000328:Adult; D002423:Cause of Death / Q000639:trends; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate / Q000639:trends; D013903:Thoracic Surgery; D014481:United States / Q000453:epidemiology