Utility of Hospital Failure to Rescue for Analyzing Variation in Pediatric Postoperative Mortality

Area of Science:

• Pediatric Surgery
• Healthcare Quality Improvement
• Patient Safety

Background:

• Failure to rescue (FTR) is a critical indicator of surgical quality, defined as postoperative mortality following a surgical complication.
• Evaluating FTR's association with mortality in patients without complications is crucial for understanding its broader impact on pediatric surgical outcomes.

Purpose of the Study:

• To assess the relationship between pediatric hospital performance in failure to rescue (FTR) and mortality rates among pediatric surgical patients who did not experience a complication.
• To determine if hospitals with higher FTR rates also exhibit increased mortality in patients without surgical complications.

Main Methods:

• Retrospective cohort study analyzing data from 48 academic pediatric hospitals between 2012 and 2020.
• Included children undergoing 57 high-risk operations; hospitals stratified by reliability-adjusted FTR quintiles.
• Multivariable hierarchical regression used to examine the association between hospital FTR performance and mortality in patients without complications.

Main Results:

• A 6.5-fold variation in reliability-adjusted FTR was observed between the lowest and highest performing hospitals.
• Hospitals with the highest FTR rates showed a 33% increased odds of mortality in patients without surgical complications compared to the lowest FTR hospitals.
• This association persisted even when analyzing subgroups of patients with complex chronic conditions and neonates.

Conclusions:

• Failure to rescue (FTR) serves as a valid quality measure in pediatric surgery, extending beyond patients with complications.
• Practices implemented to reduce FTR in high-performing hospitals may also lower the risk of postoperative mortality in children without surgical complications.