From Columbia U: Failure to Rescue After Major Gynecologic Surgery

http://www.ncbi.nlm.nih.gov/pubmed/23933221

Am J Obstet Gynecol. 2013 Aug 8. pii: S0002-9378(13)00830-2. doi: 10.1016/j.ajog.2013.08.006. [Epub ahead of print]

Failure to Rescue After Major Gynecologic Surgery.

Wright JD, Ananth CV, Ojalvo L, Herzog TJ, Lewin SN, Lu YS, Neugut AI, Hershman DL.

Source

Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons; Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons. Electronic address: jw2459@columbia.edu.

Abstract

OBJECTIVE:

There is growing recognition that, in addition to occurrence of perioperative complications, the treatment of these complications influences outcome. We examined complications, failure to rescue (death after a complication), and mortality in women who underwent abdominal hysterectomy.

STUDY DESIGN:

Women who underwent abdominal hysterectomy from 1998-2010 and were recorded in the Nationwide Inpatient Sample (NIS) were identified. Hospitals were stratified based on risk-adjusted mortality into five quintiles and rates of complications and failure to rescue were examined.

RESULTS:

A total of 664,229 women treated at 741 hospitals were identified. The overall morality rate for the cohort was 0.17%. The risk-adjusted, hospital-level mortality rate ranged from 0% to 1.12%. The complication rate was 6.5% at the lowest mortality hospitals, 9.9% at the second quintile hospitals, 9.5% at both the third and fourth quintile hospitals and 7.9% at the highest mortality hospitals. In contrast to complications, the failure to rescue rate increased with each successive risk-adjusted mortality quintile. The failure to rescue rate was 0% at the lowest mortality hospitals and then increased with each successive quintile to 1.1%, 2.1%, 2.7% and 4.4% in the highest mortality hospitals (P<0.0001).

CONCLUSION:

For women undergoing abdominal hysterectomy, hospital complication rates correlate poorly with mortality while failure to rescue is strongly associated with in-hospital mortality. The treatment of complications, not the actual development of a complication, is the most important factor predicting mortality after major gynecologic surgery.