Failure to Rescue in Emergency Surgery: Is Precedence a Problem?

Area of Science:

• Surgery
• Patient Safety
• Health Services Research

Background:

• Mortality in emergency general surgery (EGS) is often attributed to patient condition, potentially masking opportunities for improved care.
• Failure to rescue (FTR), defined as death following a complication, can identify these opportunities.
• FTR has been challenging in trauma due to low precedence rates; this study evaluated EGS.

Purpose of the Study:

• To evaluate failure to rescue (FTR) in emergency general surgery (EGS).
• To hypothesize that precedence rates in EGS are lower than in similar elective operations.
• To identify opportunities for improving care in EGS by analyzing FTR.

Main Methods:

• Utilized National Inpatient Sample data from January 2014 to September 2015.
• Defined 150,027 adult operative EGS cases based on emergent admission, specific ICD-9 procedure codes, and timing to operation (<48 hours).
• Compared precedence rates (deaths preceded by complication) between emergent and elective operations using chi-squared tests.

Main Results:

• The EGS cohort had a 2.5% mortality rate and an 84.1% precedence rate.
• Colon resection showed higher precedence in emergent (90.2%) vs. elective (82.0%) surgery (P=0.004).
• Laparotomy showed significantly lower precedence in emergent (68.8%) vs. elective (92.7%) surgery (P<0.001).

Conclusions:

• Precedence rates in EGS were higher than expected and comparable to nonemergent surgery.
• Failure to rescue (FTR) is likely a reliable metric in EGS using standard methods.
• Managing complications after emergency operations presents significant opportunities to prevent mortality.