Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective
Objective: This study evaluated interhospital variability and determinants of failure-to-rescue for patients undergoing surgical aortic valve replacement. Methods: An observational study was conducted among 28,842 patients undergoing aortic valve replacement with or without coronary artery bypass gr...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2023-12-01
|
| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273623002255 |
| _version_ | 1827578583132930048 |
|---|---|
| author | Tyler M. Bauer, MD Michael Pienta, MD, MS Xiaoting Wu, PhD Eric J. Lehr, MD, PhD Glenn J.R. Whitman, MD Robert S. Kramer, MD James Brevig, MD Francis D. Pagani, MD, PhD Donald S. Likosky, PhD |
| author_facet | Tyler M. Bauer, MD Michael Pienta, MD, MS Xiaoting Wu, PhD Eric J. Lehr, MD, PhD Glenn J.R. Whitman, MD Robert S. Kramer, MD James Brevig, MD Francis D. Pagani, MD, PhD Donald S. Likosky, PhD |
| author_sort | Tyler M. Bauer, MD |
| collection | DOAJ |
| description | Objective: This study evaluated interhospital variability and determinants of failure-to-rescue for patients undergoing surgical aortic valve replacement. Methods: An observational study was conducted among 28,842 patients undergoing aortic valve replacement with or without coronary artery bypass grafting between July 2011 and June 2017 across 90 hospitals participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Postoperative complications were defined as major (stroke, renal failure, reoperation, prolonged ventilation, sternal infection) and overall (major plus 14 other morbidities). Hospital terciles of observed to expected (O/E) mortality were compared on crude rates of major and overall complications, operative mortality, and failure to rescue (among major and overall complications). The correlation between hospital observed and expected failure-to-rescue rates was assessed. Results: Median Society of Thoracic Surgeons Adult Cardiac Surgery Database predicted mortality risk was similar across hospital O:E mortality terciles (P = .10). As expected, mortality rates significantly increased across terciles (low O/E tercile: 1.6%, high O/E tercile: 4.7%; P < .001). Failure-to-rescue rates increased substantially across hospital mortality terciles among patients with major (low tercile, 8.8% and high tercile, 20.8%) and overall (low tercile, 3.0% and high tercile, 8.9%) complications. Hospital-level expected failure to rescue had a higher correlation with observed complications for overall complications (R2 = 0.71) compared with Society of Thoracic Surgeons major complications (R2 = 0.24). Conclusions: Considerable interhospital variation exists in failure-to-rescue rates following aortic valve replacement. Hospitals in the low O/E mortality tercile experience failure to rescue nearly one-third less than those in the high O/E mortality tercile. Efforts to advance quality will benefit from identifying and disseminating optimal rescue strategies in this patient population. |
| first_indexed | 2024-03-08T21:48:34Z |
| format | Article |
| id | doaj.art-ea8fe46c222f48a6b63235829a13d9e2 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-03-08T21:48:34Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-ea8fe46c222f48a6b63235829a13d9e22023-12-20T07:38:08ZengElsevierJTCVS Open2666-27362023-12-0116123138Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspectiveTyler M. Bauer, MD0Michael Pienta, MD, MS1Xiaoting Wu, PhD2Eric J. Lehr, MD, PhD3Glenn J.R. Whitman, MD4Robert S. Kramer, MD5James Brevig, MD6Francis D. Pagani, MD, PhD7Donald S. Likosky, PhD8Department of Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WashDivision of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MdDivision of Cardiothoracic Surgery, Maine Medical Center, Portland, MaineProvidence St Joseph Heart Institute, Renton, Wash; Providence Regional Medical Center, Everett, WashDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, MichDepartment of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich; Address for reprints: Donald S. Likosky, PhD, Department of Cardiac Surgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109.Objective: This study evaluated interhospital variability and determinants of failure-to-rescue for patients undergoing surgical aortic valve replacement. Methods: An observational study was conducted among 28,842 patients undergoing aortic valve replacement with or without coronary artery bypass grafting between July 2011 and June 2017 across 90 hospitals participating in the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Postoperative complications were defined as major (stroke, renal failure, reoperation, prolonged ventilation, sternal infection) and overall (major plus 14 other morbidities). Hospital terciles of observed to expected (O/E) mortality were compared on crude rates of major and overall complications, operative mortality, and failure to rescue (among major and overall complications). The correlation between hospital observed and expected failure-to-rescue rates was assessed. Results: Median Society of Thoracic Surgeons Adult Cardiac Surgery Database predicted mortality risk was similar across hospital O:E mortality terciles (P = .10). As expected, mortality rates significantly increased across terciles (low O/E tercile: 1.6%, high O/E tercile: 4.7%; P < .001). Failure-to-rescue rates increased substantially across hospital mortality terciles among patients with major (low tercile, 8.8% and high tercile, 20.8%) and overall (low tercile, 3.0% and high tercile, 8.9%) complications. Hospital-level expected failure to rescue had a higher correlation with observed complications for overall complications (R2 = 0.71) compared with Society of Thoracic Surgeons major complications (R2 = 0.24). Conclusions: Considerable interhospital variation exists in failure-to-rescue rates following aortic valve replacement. Hospitals in the low O/E mortality tercile experience failure to rescue nearly one-third less than those in the high O/E mortality tercile. Efforts to advance quality will benefit from identifying and disseminating optimal rescue strategies in this patient population.http://www.sciencedirect.com/science/article/pii/S2666273623002255failure-to-rescueSAVRFTR |
| spellingShingle | Tyler M. Bauer, MD Michael Pienta, MD, MS Xiaoting Wu, PhD Eric J. Lehr, MD, PhD Glenn J.R. Whitman, MD Robert S. Kramer, MD James Brevig, MD Francis D. Pagani, MD, PhD Donald S. Likosky, PhD Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective JTCVS Open failure-to-rescue SAVR FTR |
| title | Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective |
| title_full | Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective |
| title_fullStr | Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective |
| title_full_unstemmed | Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective |
| title_short | Interhospital variability in failure to rescue rates following aortic valve surgeryCentral MessagePerspective |
| title_sort | interhospital variability in failure to rescue rates following aortic valve surgerycentral messageperspective |
| topic | failure-to-rescue SAVR FTR |
| url | http://www.sciencedirect.com/science/article/pii/S2666273623002255 |
| work_keys_str_mv | AT tylermbauermd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT michaelpientamdms interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT xiaotingwuphd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT ericjlehrmdphd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT glennjrwhitmanmd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT robertskramermd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT jamesbrevigmd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT francisdpaganimdphd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective AT donaldslikoskyphd interhospitalvariabilityinfailuretorescueratesfollowingaorticvalvesurgerycentralmessageperspective |