Certain hospital characteristics influence mortality after complications following high-risk surgery
Research Activities, April 2011, No. 368
Managing complications after surgery is an important part of hospital care, particularly for patients who undergo high-risk surgeries. Such patients may die after a major complication; hospitals call this "failure to rescue." Although hospitals with low and high mortality rates may have similar complication rates, there can be marked differences in failure-to-rescue rates. A new study has found that failure-to-rescue rates vary widely depending on the hospital. In addition, hospitals with the lowest rates have certain characteristics that can be attributed to better outcomes.
Researchers used 7-year data from the American Hospital Association's annual survey as well as from the Nationwide Inpatient Sample, an Agency for Healthcare Research and Quality (AHRQ) database on hospital admissions. A total of 8,862 patients at 672 hospitals were identified who had undergone removal of their pancreas (pancreatectomy), considered a high-risk surgery. The researchers examined the association between five hospital characteristics and failure-to-rescue rates: nurse-to-patient ratios, the teaching status of the hospital, the level of technology available, hospital size, and average daily census.
In general, patients undergoing this surgery at very high-mortality hospitals had a 16-fold increase in the odds of death compared with patients receiving the surgery at very low-mortality hospitals, as well as higher complication rates (33 percent vs. 18 percent). Close to a 10-fold difference was observed in failure-to-rescue rates between very low and very high mortality hospitals. Characteristics associated with favorable failure-to-rescue rates included being admitted to a teaching hospital with more than 200 beds and an average daily census of greater than 50 percent capacity. Increased nurse-to-patient ratios and strong use of hospital technology also had a positive influence. The study was supported in part by AHRQ (HS17765).
See "Hospital characteristics associated with failure to rescue from complications after pancreatectomy," by Amir A. Ghaferi, M.D., M.S., Nicholas H. Osborne, M.D., M.S., John D. Birkmeyer, M.D., and Justin B. Dimick, M.D., M.P.H., in the September 2010 Journal of the American College of Surgeons 211(3), pp. 325-330.