当前位置： SCI文献检索 > JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS期刊下所有文献 > Comparing Preoperative Targets to Failure-to-Rescue for Surgical Mortality Improvement.

Comparing Preoperative Targets to Failure-to-Rescue for Surgical Mortality Improvement.

Abstract：

BACKGROUND:Failure-to-rescue (FTR or death after postoperative complication) is thought to explain surgical mortality excesses across hospitals, and FTR is an emerging performance measure and target for quality improvement. We compared the FTR population to preoperatively identifiable subpopulations for their potential to close the mortality gap between lowest- and highest-mortality hospitals. STUDY DESIGN:Patients undergoing small bowel resection, pancreatectomy, colorectal resection, open abdominal aortic aneurysm repair, lower extremity arterial bypass, and nephrectomy were identified in the 2007 to 2011 Nationwide Inpatient Sample. Lowest- and highest-mortality hospitals were defined using risk- and reliability-adjusted mortality quintiles. Five target subpopulations were established a priori: the FTR population, predicted high-mortality risk (predicted highest-risk quintile), emergency surgery, elderly (>75 years old), and diabetic patients. RESULTS:Across the lowest mortality quintile (n=282 hospitals, 56,893 patients) and highest-mortality quintile (282 hospitals, 45,784 patients), respectively, the size of target subpopulations varied only for the FTR population (20.2% vs 22.4%, p=0.002) but not for other subpopulations. Variation in mortality rates across lowest- and highest-mortality hospitals was greatest for the high-mortality risk (7.5% vs 20.2%, p<0.0001) and FTR subpopulations (7.8% vs 18.9%, p<0.0001). The FTR and high-risk populations had comparable sensitivity (81% and 75%) and positive predictive value (19% and 20%, respectively) for mortality. In Monte Carlo simulations, the mortality gap between the lowest- and highest-mortality hospitals was reduced by nearly 75% when targeting the FTR population or the high-risk population, 78% for the emergency surgery population, but less for elderly (51%) and diabetic (17%) populations. CONCLUSIONS:Preoperatively identifiable patients with high estimated mortality risk may be preferable to the FTR population as a target for surgical mortality reduction.

journal_name

J Am Coll Surg

journal_title

Journal of the American College of Surgeons

authors

Hyder JA,Wakeam E,Adler JT,DeBord Smith A,Lipsitz SR,Nguyen LL

doi

10.1016/j.jamcollsurg.2015.02.036

subject

Has Abstract

pub_date

2015-06-01 00:00:00

pages

1096-106

issue

eissn

1072-7515

issn

1879-1190

pii

S1072-7515(15)00195-7

journal_volume

220

pub_type

杂志文章

在线工具

Comparing Preoperative Targets to Failure-to-Rescue for Surgical Mortality Improvement.