Interhospital failure to rescue after coronary artery bypass grafting.
complications
coronary artery bypass grafting
mortality
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
01 2023
01 2023
Historique:
received:
31
07
2020
revised:
06
01
2021
accepted:
12
01
2021
pubmed:
14
3
2021
medline:
17
12
2022
entrez:
13
3
2021
Statut:
ppublish
Résumé
We evaluated whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue. An observational study was conducted among 83,747 patients undergoing isolated coronary artery bypass grafting between July 2011 and June 2017 across 90 hospitals. Failure to rescue was defined as operative mortality among patients developing complications. Complications included the Society of Thoracic Surgeons 5 major complications (stroke, surgical reexploration, deep sternal wound infection, renal failure, prolonged intubation) and a broader set of 19 overall complications. After creating terciles of hospital performance (based on observed:expected mortality), each tercile was compared on the basis of crude rates of (1) major and overall complications, (2) operative mortality, and (3) failure to rescue (among major and overall complications). The correlation between hospital observed and expected (to address confounding) failure to rescue rates was assessed. Median Society of Thoracic Surgeons predicted mortality risk was similar across hospital observed:expected mortality terciles (P = .831). Mortality rates significantly increased across terciles (low tercile: 1.4%, high tercile: 2.8%). Although small in magnitude, rates of major (low tercile: 11.1%, high tercile: 12.2%) and overall (low tercile: 36.6%, high tercile: 35.3%) complications significantly differed across terciles. Nonetheless, failure to rescue rates increased substantially across terciles among patients with major (low tercile: 9.1%, high tercile: 14.3%) and overall (low tercile: 3.3%, high tercile: 6.8%) complications. Hospital observed and expected failure to rescue rates were positively correlated among patients with major (R The reported interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals, including early recognition and management of complications.
Identifiants
pubmed: 33712236
pii: S0022-5223(21)00163-X
doi: 10.1016/j.jtcvs.2021.01.064
pmc: PMC8679510
mid: NIHMS1718519
pii:
doi:
Types de publication
Observational Study
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
134-143.e3Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL146619
Pays : United States
Organisme : NCATS NIH HHS
ID : TL1 TR002242
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS026003
Pays : United States
Organisme : NHLBI NIH HHS
ID : T35 HL007690
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Références
Ann Thorac Surg. 2009 Jul;88(1 Suppl):S2-22
pubmed: 19559822
Adv Health Care Manag. 2019 Oct 24;18:
pubmed: 32077653
JAMA. 2002 Oct 23-30;288(16):1987-93
pubmed: 12387650
JAMA Surg. 2014 Feb;149(2):119-23
pubmed: 24336902
J Am Coll Surg. 2010 Sep;211(3):325-30
pubmed: 20800188
JAMA. 2003 Sep 24;290(12):1617-23
pubmed: 14506121
Circ Cardiovasc Qual Outcomes. 2018 Nov;11(11):e004756
pubmed: 30571334
World J Surg. 2014 Jun;38(6):1362-73
pubmed: 24370544
Ann Surg. 2019 Jul;270(1):91-94
pubmed: 29557884
Health Serv Res. 2008 Aug;43(4):1145-63
pubmed: 18248404
Med Care. 1992 Jul;30(7):615-29
pubmed: 1614231
Surgery. 2015 Aug;158(2):393-8
pubmed: 26013985
Ann Surg. 2009 Dec;250(6):1029-34
pubmed: 19953723
Surgery. 2015 Apr;157(4):752-63
pubmed: 25794627
Ann Thorac Surg. 2016 Aug;102(2):458-64
pubmed: 27344280
Ann Thorac Surg. 2012 Aug;94(2):573-9; discussion 579-80
pubmed: 22633496
Crit Care Med. 2013 Oct;41(10):2284-91
pubmed: 23921274
Br J Surg. 2016 Jan;103(2):e47-51
pubmed: 26616276
Ann Thorac Surg. 2013 Jun;95(6):1976-81; discussion 1981
pubmed: 23642682
Crit Care. 2011;15(6):R269
pubmed: 22085785