RT Journal Article
SR Electronic
T1 Failure to rescue in emergency general surgery in Canada
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP E215
OP E220
DO 10.1503/cjs.008820
VO 65
IS 2
A1 Samuel Minor
A1 Laura Allen
A1 Michael T. Meschino
A1 Rahima Nenshi
A1 Rardi van Heest
A1 Fady Saleh
A1 Sandy Widder
A1 Paul T. Engels
A1 Emilie Joos
A1 Neil G. Parry
A1 Patrick B. Murphy
A1 Chad G. Ball
A1 Morad Hameed
A1 Kelly N. Vogt
A1 ,
YR 2022
UL http://canjsurg.ca/content/65/2/E215.abstract
AB Background: The risk of death after a postoperative complication — known as failure to rescue (FTR) — has been proposed to be superior to traditional benchmarking outcomes, such as complication and mortality rates, as a measure of system quality. The purpose of this study was to identify the current FTR rate in emergency general surgery (EGS) centres across Canada. We hypothesized that substantial variability exists in FTR rates across centres.Methods: In this multicentre retrospective cohort study, we performed a secondary analysis of data from a previous study designed to evaluate operative intervention for nonappendiceal, nonbiliary disease by 6 EGS services across Canada (1 in British Columbia, 1 in Alberta, 3 in Ontario and 1 in Nova Scotia). Patients underwent surgery between Jan. 1 and Dec. 31, 2014. We conducted univariate analyses to compare patients with and without complications. We performed a sensitivity analysis examining the mortality rate after serious complications (Clavien–Dindo score 3 or 4) that required a surgical intervention or specialized care (e.g., admission to intensive care unit).Results: A total of 2595 patients were included in the study cohort. Of the 206 patients who died within 30 days, 145 (70.4%) experienced a complication before their death. Overall, the mortality rate after any surgical complication (i.e., FTR) was 16.0%. Ranking of sites by the traditional outcomes of complication and mortality rates differed from the ranking when FTR rate was included in the assessment.Conclusion: There was variability in FTR rates across EGS services in Canada, which suggests that there is opportunity for ongoing quality-improvement efforts. This study provides FTR benchmarking data for Canadian EGS services.