TY - JOUR
T1 - Failure to Rescue - a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands
AU - Lijftogt, Niki
AU - Karthaus, Eleonora G
AU - Vahl, Anco
AU - van Zwet, Erik W
AU - van der Willik, Esmee M
AU - Tollenaar, Robertus A E M
AU - Hamming, Jaap F
AU - Wouters, Michel W J M
AU - Hazenberg, CEVB
AU - de Borst, Gert Jan
N1 - Funding Information:
The authors would like to thank the members of the Dutch Society for Vascular Surgery who registered their patients in the DSAA, the Dutch Institute for Clinical Auditing that facilitated the registry and the Dutch Surgical Aneurysm Audit group.
Publisher Copyright:
© 2018 European Society for Vascular Surgery
PY - 2018/11/1
Y1 - 2018/11/1
N2 - OBJECTIVES: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.METHODS: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.RESULTS: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5-65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0-16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0-60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49-0.78; and 0.64, 95% CI 0.48-0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.CONCLUSIONS: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines.
AB - OBJECTIVES: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.METHODS: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.RESULTS: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5-65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0-16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0-60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49-0.78; and 0.64, 95% CI 0.48-0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.CONCLUSIONS: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines.
KW - Aortic Aneurysm, Abdominal/mortality
KW - Elective Surgical Procedures/adverse effects
KW - Endovascular Procedures/adverse effects
KW - Hospital Mortality
KW - Hospitals
KW - Humans
KW - Netherlands
KW - Postoperative Complications/etiology
KW - Quality Improvement
KW - Time Factors
KW - Failure to rescue
KW - Abdominal aortic aneurysm
KW - Clinical audit
KW - Surgical outcome
KW - Composite outcome measures
UR - http://www.scopus.com/inward/record.url?scp=85051989088&partnerID=8YFLogxK
U2 - 10.1016/j.ejvs.2018.06.062
DO - 10.1016/j.ejvs.2018.06.062
M3 - Article
C2 - 30145163
SN - 1078-5884
VL - 56
SP - 652
EP - 661
JO - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery
IS - 5
ER -