The following is a summary of “Interhospital variability in failure to rescue rates following aortic valve surgery,” published in the September 2023 issue of Surgery by Bauer et al.
This study aimed to assess the differences in failure-to-rescue rates among patients undergoing surgical aortic valve replacement and identify the underlying determinants of these variations. A total of 28,842 patients who had undergone the replacement of the aortic valve, with or without coronary artery bypass grafting, were analyzed across 90 participating hospitals associated with the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2011 to June 2017.
Postoperative complications were categorized as major (including stroke, renal failure, reoperation, prolonged ventilation, and sternal infection) and overall (comprising major complications and 14 additional morbidities). Hospitals were divided into terciles based on observed to expected (O/E) mortality rates, and comparisons were made regarding major and overall complication rates, operative mortality, and failure-to-rescue rates for both major and overall complications. Results showed similar predicted mortality risks among hospitals, although mortality rates increased significantly across terciles, ranging from 1.6% in the low tercile to 4.7% in the high tercile (P < .001). Failure-to-rescue rates notably increased across hospital mortality terciles among patients with significant complications (8.8% in the low tercile and 20.8% in the high tercile) and overall complications (3.0% in the low tercile and 8.9% in the high tercile).
Additionally, there was a higher correlation between hospital-level expected failure-to-rescue rates and observed complications for overall complications (R2 = 0.71) compared to the Society of Thoracic Surgeons major complications (R2 = 0.24). These findings underscore significant hospital variability in failure-to-rescue rates following aortic valve replacement. Hospitals in the low O/E mortality tercile demonstrate notably lower rates of failure to rescue than those in the high O/E mortality tercile. Enhancing the quality of care in this patient cohort will benefit from identifying and disseminating optimal rescue strategies across healthcare facilities.
Source: sciencedirect.com/science/article/pii/S2666273623002255
