Abstract
Methods. We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest).
Results. A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a threefold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failureto- rescue, indicating differences between hospitals in the risk of death among patients after they develop complications.
Conclusions. Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.
Original language | English |
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Pages (from-to) | 258-266 |
Number of pages | 9 |
Journal | British Journal of Anaesthesia |
Volume | 119 |
Issue number | 2 |
DOIs | |
Publication status | Published - Aug 2017 |
Keywords
- postoperative care, methods
- postoperative care, statistics and numerical data
- surgical procedures, operative, mortality
- HIGH-RISK SURGERY
- HOSPITAL MORTALITY
- SURGICAL MORTALITY
- PATIENT MORTALITY
- CANCER-SURGERY
- GLOBAL HEALTH
- COMPLICATIONS
- OUTCOMES
- QUALITY
- VOLUME