Failure to rescue following emergency general surgery: A national analysis

Jeffrey Balian; Nam Yong Cho, BS; Amulya Vadlakonda, BS; Oh. Jin Kwon, MD; Giselle Porter, BS; Saad Mallick, MD; Peyman Benharash, MD

Surgery Open Science (Aug 2024)

Failure to rescue following emergency general surgery: A national analysis

Jeffrey Balian,
Nam Yong Cho, BS,
Amulya Vadlakonda, BS,
Oh. Jin Kwon, MD,
Giselle Porter, BS,
Saad Mallick, MD,
Peyman Benharash, MD

Affiliations

Jeffrey Balian: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Nam Yong Cho, BS: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Amulya Vadlakonda, BS: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Oh. Jin Kwon, MD: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Giselle Porter, BS: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Saad Mallick, MD: Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
Peyman Benharash, MD: Corresponding author at: 10833 Le Conte Avenue, UCLA Center for Health Sciences, Room 64-249, Los Angeles, CA 90095, USA.; Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

Journal volume & issue: Vol. 20
pp. 77 – 81

Abstract

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Background: Failure to rescue (FTR) is increasingly recognized as a quality metric but remains understudied in emergency general surgery (EGS). We sought to identify patient and operative factors associated with FTR to better inform standardized metrics to mitigate this potentially preventable event. Methods: All adult (≥18 years) non-elective hospitalizations for large bowel resection, small bowel resection, repair of perforated ulcer, laparotomy and lysis of adhesions were identified in the 2016–2020 National Readmissions Database. Patients undergoing trauma-related operations or procedures ≤2 days of admission were excluded. FTR was defined as in-hospital death following acute kidney injury requiring dialysis (AKI), myocardial infarction, pneumonia, respiratory failure, sepsis, stroke, or thromboembolism. Multilevel mixed-effect models were developed to assess factors linked with FTR. Results: Among 826,548 EGS operations satisfying inclusion criteria, 298,062 (36.1 %) developed at least one MAE. Of those experiencing MAE, 43,477 (14.6 %) ultimately did not survive to discharge (FTR). Following adjustment for fixed hospital level effects, only 3.5 % of the variance in FTR was attributable to center-level differences. Relative to private insurance and the highest income quartile, Medicaid insurance (AOR 1.33; 95%CI, 1.23–1.43) and the lowest income quartile (AOR 1.22; 95%CI, 1.17–1.29) were linked with increased odds of FTR.A subset analysis stratified complication-specific rates of FTR by insurance status. Relative to private insurance, Medicaid coverage and uninsured status were linked with greater odds of FTR following perioperative sepsis, pneumonia, and AKI. Conclusion: Our findings underscore the need for increased screening and vigilance following perioperative complications to mitigate disparities in patient outcomes following high-risk EGS.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

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