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Between-Hospital Variation in Failure to Rescue After Major Surgery.

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Nearly 1 in 5 surgical patients with complications died, highlighting significant hospital variation in failure to rescue (FTR) rates. Institutional performance accounted for over 1000 potentially avoidable deaths, underscoring FTR as a key patient safety indicator.

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Area of Science:

  • Healthcare Quality and Safety
  • Surgical Patient Outcomes
  • Health Services Research

Background:

  • Failure to rescue (FTR), defined as postoperative mortality following treatable complications, is a critical patient safety concern.
  • FTR reflects institutional capacity for managing patient deterioration and is proposed as a quality indicator.
  • Limited evidence exists on systematic hospital-level variation in FTR outside the United States.

Purpose of the Study:

  • To estimate national postoperative FTR rates in Switzerland.
  • To quantify between-hospital variation in FTR.
  • To identify hospitals with better- or worse-than-expected performance using risk-standardized mortality ratios (RSMRs).

Main Methods:

  • Retrospective cohort study using administrative hospital data from Switzerland (2019-2023).
  • Applied Agency for Healthcare Research and Quality (AHRQ) patient safety indicator 04 (PSI04) definition to surgical inpatients with specific complications.
  • Utilized multilevel logistic regression and RSMRs to assess hospital-level variation and performance.

Main Results:

  • The crude national FTR rate was 18.07%.
  • Significant variation in mortality was observed across hospitals, with adjusted odds ratios ranging from 0.56 to 1.75.
  • Institutional performance accounted for an estimated 1045 potentially avoidable deaths, with 23% of hospitals performing worse than expected.

Conclusions:

  • Substantial between-hospital variation exists in failure to rescue rates following surgical complications.
  • Institutional performance significantly impacts patient outcomes, with a notable number of deaths potentially avoidable.
  • FTR serves as a valuable international patient safety indicator, necessitating investigation into organizational factors driving performance variation.