Variation and Impact of Multiple Complications on Failure to Rescue After Inpatient Surgery.

Abstract:

OBJECTIVE:To examine the extent to which multiple, sequential complications impacts variation in institutional postoperative mortality rates. BACKGROUND:Failure to rescue (FTR) has been proposed as an underlying factor in hospital variation in surgical mortality. However, little is currently known about hospital variation in FTR after multiple complications or the contribution of sequential complications to variation. METHODS:Retrospective cohort study of 266,101 patients within the Veterans Affairs Surgical Quality Improvement Program (2000-2014) who underwent a subset of high-mortality inpatient general, vascular, or thoracic procedures. The association between number of postoperative complications (0, 1, 2, or ≥3) and 30-day mortality across quintiles of hospital risk-adjusted mortality was evaluated with multivariable, multilevel mixed-effects models. RESULTS:Among patients who had a complication, over half (60.9%) had 1, but those with more than 1 accounted for the majority of the deaths (63.1%). Across hospital quintiles, there were no differences in complications (23.5% very low mortality vs 23.6% very high mortality; trend test P = 0.15). FTR increased significantly (12.0% vs 18.1%; trend test P < 0.001) with an incremental impact as complications accrued (6.7% 1 complication vs 26.1% ≥3, lowest quintile; 11.7% 1 complication vs 33.0% ≥3, highest quintile). However, the risk of FTR associated with increasing complications remained relatively constant across hospital quintiles and was not explained by differences in patients presenting with multiple complications on the index complicated day. CONCLUSIONS:FTR occurs predominantly among patients who have more than 1 complication with a dose-response relationship as complications accrue. As this dose-response relationship is observed across hospitals, surgical quality improvement efforts may benefit by shifting focus to broader interventions designed to prevent subsequent complications at all hospitals.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Massarweh NN,Anaya DA,Kougias P,Bakaeen FG,Awad SS,Berger DH

doi

10.1097/SLA.0000000000001917

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

59-65

issue

1

eissn

0003-4932

issn

1528-1140

journal_volume

266

pub_type

杂志文章
  • Pylorus Resection Does Not Reduce Delayed Gastric Emptying After Partial Pancreatoduodenectomy: A Blinded Randomized Controlled Trial (PROPP Study, DRKS00004191).

    abstract:OBJECTIVES:The aim of this study was to investigate the effect of pylorus resection on postoperative delayed gastric emptying (DGE) after partial pancreatoduodenectomy (PD). BACKGROUND:PD is the standard treatment for tumors of the pancreatic head. Preservation of the pylorus has been widely accepted as standard proce...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/SLA.0000000000002480

    authors: Hackert T,Probst P,Knebel P,Doerr-Harim C,Bruckner T,Klaiber U,Werner J,Schneider L,Michalski CW,Strobel O,Ulrich A,Diener MK,Büchler MW

    更新日期:2018-06-01 00:00:00

  • Laparoscopic liver resections: a feasibility study in 30 patients.

    abstract:OBJECTIVE:To assess the feasibility and safety of laparoscopic liver resections. SUMMARY BACKGROUND DATA:The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to conside...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-200012000-00004

    authors: Cherqui D,Husson E,Hammoud R,Malassagne B,Stéphan F,Bensaid S,Rotman N,Fagniez PL

    更新日期:2000-12-01 00:00:00

  • Ventricular assist devices as a bridge to cardiac transplantation. A prelude to destination therapy.

    abstract:OBJECTIVE AND BACKGROUND:Ventricular assist devices (VADs) have been used for temporary circulatory support pending transplantation or recovery of the native heart. Outcome in 38 patients treated at the authors' institution with VADs pending transplantation was analyzed to provide information relevant to the future use...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199706000-00007

    authors: Holman WL,Bourge RC,Spruell RD,Murrah CP,McGiffin DC,Kirklin JK

    更新日期:1997-06-01 00:00:00

  • Hyperparathyroidism in the elderly.

    abstract::Primary hyperparathyroidism was studied in a well-defined geriatric population of 1129 individuals during a three-month interval. Primary hyperparathyroidism was diagnosed in 1.5%. The diagnosis was based on a morphologic and biochemic basis. From clinical material consisting of 400 patients treated surgically for pri...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198302000-00003

    authors: Tibblin S,Pålsson N,Rydberg J

    更新日期:1983-02-01 00:00:00

  • Early endoscopic retrograde cholangiopancreatography in predicted severe acute biliary pancreatitis: a prospective multicenter study.

    abstract:SUMMARY BACKGROUND DATA:The role of early endoscopic retrograde cholangiopancreatography (ERCP) in acute biliary pancreatitis (ABP) remains controversial. Previous studies have included only a relatively small number of patients with predicted severe ABP. We investigated the clinical effects of early ERCP in these pati...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究,随机对照试验

    doi:10.1097/SLA.0b013e3181a77bb4

    authors: van Santvoort HC,Besselink MG,de Vries AC,Boermeester MA,Fischer K,Bollen TL,Cirkel GA,Schaapherder AF,Nieuwenhuijs VB,van Goor H,Dejong CH,van Eijck CH,Witteman BJ,Weusten BL,van Laarhoven CJ,Wahab PJ,Tan AC,Schwartz M

    更新日期:2009-07-01 00:00:00

  • Aspirin and dipyridamole decrease intimal hyperplasia in experimental vein grafts.

    abstract::Release from platelets of a factor mitogenic for smooth muscle cells is a postulated mechanism for the pathogenesis of vascular intimal hyperplasia. In this study the effect of antiplatelet therapy was evaluated. Aspirin (165 mg twice daily) and dipyridamole (25 mg twice daily) were administered to six rhesus monkeys ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198002000-00018

    authors: McCann RL,Hagen PO,Fuchs JC

    更新日期:1980-02-01 00:00:00

  • Role of insulin as a portal factor in maintaining the viability of liver.

    abstract::The subcutaneous administration of insulin did not induce a significant effect on oxidative phosphorylation of the mitochondria from normal rat liver. However, in rats subjected to ligation of a branch of portal vein, the phosphorylative activity of the mitochondria from the ligated lobe deprived of portal blood fell ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197411000-00002

    authors: Ozawa K,Yamada T,Honjo I

    更新日期:1974-11-01 00:00:00

  • Survival and function of hepatocytes on a novel three-dimensional synthetic biodegradable polymer scaffold with an intrinsic network of channels.

    abstract:OBJECTIVE:To evaluate the survival and function of hepatocytes (HCs) on a novel three-dimensional (3D) synthetic biodegradable polymer scaffold with an intrinsic network of interconnected channels under continuous flow conditions. SUMMARY BACKGROUND DATA:The authors' laboratory has investigated HC transplantation usin...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-199807000-00002

    authors: Kim SS,Utsunomiya H,Koski JA,Wu BM,Cima MJ,Sohn J,Mukai K,Griffith LG,Vacanti JP

    更新日期:1998-07-01 00:00:00

  • Gastrocolic fistulae in benign peptic ulcer disease.

    abstract::Occurence of gastroenteric fistulae in non-surgically treated peptic ulcer disease is rare as suggested by only 26 cases published in the literature so far. We had the opportunity to care for 3 patients with this problem in a period of one year. At our institution, a search of the medical records dating back to 1955 y...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197608000-00017

    authors: Kumar GK,Razzaque MA,Naidu VG,Barbour EM

    更新日期:1976-08-01 00:00:00

  • Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy.

    abstract:OBJECTIVE:This multicenter study sought to evaluate the accuracy of the American College of Surgeons National Surgical Quality Improvement Program's (ACS-NSQIP) surgical risk calculator for predicting outcomes after pancreatoduodenectomy (PD) and to determine whether incorporating other factors improves its predictive ...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0000000000001796

    authors: McMillan MT,Allegrini V,Asbun HJ,Ball CG,Bassi C,Beane JD,Behrman SW,Berger AC,Bloomston M,Callery MP,Christein JD,Dickson E,Dixon E,Drebin JA,Fernandez-Del Castillo C,Fisher WE,Fong ZV,Haverick E,Hollis RH,House MG

    更新日期:2017-05-01 00:00:00

  • Increased use of parenchymal-sparing surgery for bilateral liver metastases from colorectal cancer is associated with improved mortality without change in oncologic outcome: trends in treatment over time in 440 patients.

    abstract:OBJECTIVE:The aim of this study was to determine the results of liver resection for patients with bilateral hepatic metastases from colorectal cancer. We aimed to assess the evolution of the technical approach over time and correlations with morbidity, mortality, and oncologic outcome. SUMMARY BACKGROUND DATA:Although...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e3181557e47

    authors: Gold JS,Are C,Kornprat P,Jarnagin WR,Gönen M,Fong Y,DeMatteo RP,Blumgart LH,D'Angelica M

    更新日期:2008-01-01 00:00:00

  • Conversion for Unfavorable Intraoperative Events Results in Significantly Worse Outcomes During Laparoscopic Liver Resection: Lessons Learned From a Multicenter Review of 2861 Cases.

    abstract:OBJECTIVE:To investigate the risk factors for conversion during laparoscopic liver resection and its effect on patient outcome in a large cohort of patients. Additional analysis of outcomes in patients who required conversion for unfavorable intraoperative findings and conversion for unfavorable intraoperative events w...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/SLA.0000000000002332

    authors: Halls MC,Cipriani F,Berardi G,Barkhatov L,Lainas P,Alzoubi M,D'Hondt M,Rotellar F,Dagher I,Aldrighetti L,Troisi RI,Edwin B,Abu Hilal M

    更新日期:2018-12-01 00:00:00

  • Variceal recurrence, rebleeding, and survival after endoscopic injection sclerotherapy in 287 alcoholic cirrhotic patients with bleeding esophageal varices.

    abstract:OBJECTIVE:This study tested the validity of the hypothesis that eradication of esophageal varices by repeated injection sclerotherapy would reduce recurrent variceal bleeding and death from bleeding varices in a high-risk cohort of alcoholic patients with cirrhosis. SUMMARY BACKGROUND DATA:Although banding of esophage...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/01.sla.0000231704.45005.4e

    authors: Krige JE,Kotze UK,Bornman PC,Shaw JM,Klipin M

    更新日期:2006-11-01 00:00:00

  • Treatment of intra-abdominal and abdominal wall desmoid tumors with drugs that affect the metabolism of cyclic 3',5'-adenosine monophosphate.

    abstract::A female patient with Gardner's syndrome was treated with delta1-testololactone (200 mg daily) because of growth of a large desmoid tumor in the pelvis and lower abdomen and a tumor in a scar from a previous laparotomy. There was also pain and swelling of the left leg. An immediate effect of the drug therapy was compl...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197503000-00009

    authors: Waddell WR

    更新日期:1975-03-01 00:00:00

  • Treatment of symptomatic gastroesophageal reflux using the Angelchik prosthesis.

    abstract::During the past 20 months, 28 patients with symptomatic gastroesophageal reflux were treated with the Angelchik anti-reflux prosthesis. The patients ranged in age from 12 to 75 years, with symptoms present from one to 24 years. Vigorous medical management had failed with all patients prior to surgery. Before operation...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198206000-00002

    authors: Starling JR,Reichelderfer MO,Pellett JR,Belzer FO

    更新日期:1982-06-01 00:00:00

  • Smartphone-Based Assessment of Preoperative Decision Conflict and Postoperative Physical Activity Among Patients Undergoing Cancer Surgery: A Prospective Cohort Study.

    abstract:OBJECTIVE:To determine the prevalence of clinically significant decision conflict (CSDC) among patients undergoing cancer surgery and associations with postoperative physical activity, as measured through smartphone accelerometer data. BACKGROUND:Patients with cancer face challenging treatment decisions, which may lea...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0000000000004487

    authors: Panda N,Solsky I,Cauley CE,Lipsitz S,Desai EV,Huang EJ,Benjamin EM,Lubitz CC,Onnela JP,Haynes AB

    更新日期:2020-09-15 00:00:00

  • Transplantation of pediatric donor kidneys to adult recipients. Is there a critical donor age?

    abstract::Cadaver kidneys remain a scarce resource, yet single pediatric donor kidneys are underutilized at some centers. Between 1967 and 1984, 133 single pediatric and 318 adult donor cadaver transplants were performed. Patient and graft survival, renal function, and complications in adult recipients grouped by donor age were...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198608000-00011

    authors: Wengerter K,Matas AJ,Tellis VA,Quinn T,Soberman R,Veith FJ

    更新日期:1986-08-01 00:00:00

  • Percutaneous transluminal angioplasty as an adjunct to the surgical management of peripheral vascular disease.

    abstract::Percutaneous transluminal angioplasty (PTA) was performed as an adjunct to an operation in 43 patients with peripheral arterial insufficiency. This represents 26% of patients undergoing PTA over the past 44 months. In 23 patients PTA was done in conjunction with planned vascular reconstruction. It was successful in al...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198206000-00016

    authors: Kadir S,Smith GW,White RI Jr,Kaufman SL,Barth KH,Williams GM,O'Mara CS,Burdick JF

    更新日期:1982-06-01 00:00:00

  • Detrimental effects of removing end-expiratory pressure prior to endotracheal extubation.

    abstract::Patients recovering from acute respiratory insufficiency are usually not extubated until they can ventilate adequately while breathing spontaneously at ambient end-expiratory pressure (T-tube). It is hypothesized that this period of T-tube breathing might be detrimental to gas exchange since the endotracheal tube abol...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198005000-00004

    authors: Annest SJ,Gottlieb M,Paloski WH,Stratton H,Newell JC,Dutton R,Powers SR Jr

    更新日期:1980-05-01 00:00:00

  • Training future surgical scientists: realities and recommendations.

    abstract:OBJECTIVE:To examine factors influencing surgical research and assess the current state of training future surgical scientists. SUMMARY BACKGROUND DATA:The number of surgeons actively engaged in research seems to be decreasing. Training future surgical scientists to increase these numbers depends on a variety of facto...

    journal_title:Annals of surgery

    pub_type: 杂志文章,评审

    doi:10.1097/SLA.0b013e318163d27d

    authors: Suliburk JW,Kao LS,Kozar RA,Mercer DW

    更新日期:2008-05-01 00:00:00

  • Clinicopathologic factors associated with false-negative sentinel lymph-node biopsy in breast cancer.

    abstract:SUMMARY BACKGROUND DATA:Previous studies have suggested a variety of factors that may affect the false negative (FN) rate for sentinel lymph node (SLN) biopsy in breast cancer. Because FN results are relatively rare, no prior studies have had sufficient sample size to allow detailed statistical analysis of factors pred...

    journal_title:Annals of surgery

    pub_type: 杂志文章,多中心研究

    doi:10.1097/01.sla.0000165200.32722.02

    authors: Martin RC 2nd,Chagpar A,Scoggins CR,Edwards MJ,Hagendoorn L,Stromberg AJ,McMasters KM,University of Louisville Breast Cancer Sentinel Lymph Node Study.

    更新日期:2005-06-01 00:00:00

  • Quantification of asymmetric lung pathophysiology as a guide to the use of simultaneous independent lung ventilation in posttraumatic and septic adult respiratory distress syndrome.

    abstract::The management of impaired respiratory gas exchange in patients with nonuniform posttraumatic and septic adult respiratory distress syndrome (ARDS) contains its own therapeutic paradox, since the need for volume-controlled ventilation and PEEP in the lung with the most reduced compliance increases pulmonary barotrauma...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198510000-00004

    authors: Siegel JH,Stoklosa JC,Borg U,Wiles CE 3rd,Sganga G,Geisler FH,Belzberg H,Wedel S,Blevins S,Goh KC

    更新日期:1985-10-01 00:00:00

  • Blood cardioplegia delivery. Deleterious effects of potassium versus lidocaine.

    abstract::Delivery of cardioplegic (CP) solutions to all regions of the myocardium is critical for optimal myocardial protection during cardiac surgery. However, there are little data regarding the effects of CP agents upon coronary vascular resistance (CVR) and CP delivery. Accordingly, we evaluated blood CP (Hct 30) delivery ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198309000-00003

    authors: Leicher FG,Magrassi P,LaRaia PJ,Derkac WM,Buckley MJ,Austen WG

    更新日期:1983-09-01 00:00:00

  • Patterns of failure in patients with resected stage I and II non-small-cell carcinoma of the lung. The Ludwig Lung Cancer Study Group.

    abstract::The pattern of failure was studied in 1012 patients with resected Stage I or II non-small-cell carcinoma of the lung. Initial intrathoracic failure (41%) was more common than initial extrathoracic failure (34%) even though a complete resection was the intent in all patients. The most frequent sites of initial failure ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-198701000-00012

    authors:

    更新日期:1987-01-01 00:00:00

  • Effect of proximal gastric vagotomy on feeding stimulated Heidenhain pouch acid secretion and gastrin release.

    abstract::Truncal vagotomy (TV) is known to increase the feeding stimulated acid output of Heidenhain pouches. A series of experiments were performed in dogs to see if proximal gastric vagotomy (PGV) also had this effect. Dogs were prepared with gastric fistulas (GF) and Heidenhain pouches (HP). Gastric function testing include...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197811000-00011

    authors: Harmon JW,Trout HH 3rd

    更新日期:1978-11-01 00:00:00

  • Multiple subcritical arterial stenoses: effect on poststenotic pressure and flow.

    abstract::Diminished poststenotic pressure and flow accompanied experimental application of multiple subcritical arterial stenoses in series. Effects of additional stenoses, causing equivalent constrictions, were cumulative in a nonlinear fashion. Seven-hundred-twenty measurements were performed using 10 cm ileofemoral canine a...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197711000-00020

    authors: Flanigan DP,Tullis JP,Streeter VL,Whitehouse WM Jr,Fry WJ,Stanley JC

    更新日期:1977-11-01 00:00:00

  • The choice of primary repair or mesh repair for paraesophageal hernia: a decision analysis based on utility scores.

    abstract:BACKGROUND:Controversy exists on the use of mesh in the repair of paraesophageal hernias (PEH). This debate centers around the type of mesh used, its value in preventing recurrence, its short- and long-term complications, and the consequences of those complications compared with primary repair. Decision analysis is a m...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/SLA.0b013e3182822c8c

    authors: Obeid NM,Velanovich V

    更新日期:2013-04-01 00:00:00

  • Aneurysm of the aorta treated by wiring: case report of a 38-year survival.

    abstract::A patient with a syphilitic aneurysm of the aorta treated by the insertion of wire is presented. The patient remained well for almost 40 years, but finally succumbed after rupture. The autopsy findings are discussed. To our knowledge, this represents the longest reported survival after treatment of an aortic aneurysm ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/00000658-197612000-00014

    authors: Altman P,Voorhees AB Jr

    更新日期:1976-12-01 00:00:00

  • Impact of hospital volume on recurrence and survival after surgery for gastric cancer.

    abstract:BACKGROUND:Some, but not all, studies using registry data have suggested a small but significant long-term survival advantage following a curative surgical resection of gastric cancer at hospitals where the volume of such surgeries is high. However, because such data may be significantly influenced by the impact of pos...

    journal_title:Annals of surgery

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/01.sla.0000245469.35088.42

    authors: Enzinger PC,Benedetti JK,Meyerhardt JA,McCoy S,Hundahl SA,Macdonald JS,Fuchs CS

    更新日期:2007-03-01 00:00:00

  • A novel approach to high definition, high-contrast video capture in abdominal surgery.

    abstract:OBJECTIVE:The aim of this study was to define the best available option for video capture of surgical procedures for educational and archival purposes, with a view to identifying methods of capturing high-quality footage and identifying common pitfalls. SUMMARY BACKGROUND DATA:Several options exist for those who wish ...

    journal_title:Annals of surgery

    pub_type: 杂志文章

    doi:10.1097/01.sla.0000250441.69758.cd

    authors: Cosman PH,Shearer CJ,Hugh TJ,Biankin AV,Merrett ND

    更新日期:2007-04-01 00:00:00