Effect of multiple complications on postop mortality rates

Editor's Note

Failure to rescue occurs predominantly in patients who have more than one complication with a dose-response relationship as complications accrue, this study finds.

More than 266,000 patients in the Veterans Affairs Surgical Quality Improvement Program were included in the analysis. Of those who had a complication, more than half (60.9%) had one, but those with more than one accounted for the majority of deaths (63.1%).

Failure to rescue increased significantly (12.0% vs 18.1%) with an incremental impact as complications accrued. However, the risk of failure to rescue associated with increasing complications remained constant across hospital quintiles and was not explained by difference in patients presenting with multiple complications on the index complication day.

Surgical quality improvement efforts may benefit from broad interventions to prevent subsequent complications at all hospitals, the authors say.

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 k...