PURPOSE/ OBJECTIVES: To analyze the frequency, type, and correlates of postoperative complications for surgical patients with cancer to illustrate practical application of the failure to rescue concept in oncology nursing practice. DESIGN: Secondary analysis of inpatient claims. SETTING: Data obtained from the Pennsylvania Health Care Cost Containment Council were linked with data from the Pennsylvania Cancer Registry. SAMPLE: 24,618 patients with solid tumors hospitalized for tumor-directed surgery in 164 acute care hospitals from 1998-1999. METHODS: Frequency distributions examined the incidence of each complication, the proportion of patients who died with the complication, and complication frequency by tumor type. Chi-square tests compared the frequency of complications for patients who were admitted routinely or via the emergency department. MAIN RESEARCH VARIABLES: 30-day mortality, postoperative complications, and tumor type. FINDINGS: The most frequent complication in the sample was gastrointestinal bleeding (13.2%); however, 37.1% of patients who died had respiratory compromise as a complication. Admission through the emergency department was significantly associated with experiencing a complication (71.9% versus 43.9%). CONCLUSIONS: Treatable but serious postoperative complications are frequent and can be fatal in the surgical oncology population. Complication frequency and fatality vary significantly by cancer type. IMPLICATIONS FOR NURSING: The complications studied are detectable by nurses and can be managed successfully with timely intervention. Recognition of complications at an early stage and evidence-based management may assist nurses in patient rescue and, ultimately, improve quality of care.
PURPOSE/ OBJECTIVES: To analyze the frequency, type, and correlates of postoperative complications for surgical patients with cancer to illustrate practical application of the failure to rescue concept in oncology nursing practice. DESIGN: Secondary analysis of inpatient claims. SETTING: Data obtained from the Pennsylvania Health Care Cost Containment Council were linked with data from the Pennsylvania Cancer Registry. SAMPLE: 24,618 patients with solid tumors hospitalized for tumor-directed surgery in 164 acute care hospitals from 1998-1999. METHODS: Frequency distributions examined the incidence of each complication, the proportion of patients who died with the complication, and complication frequency by tumor type. Chi-square tests compared the frequency of complications for patients who were admitted routinely or via the emergency department. MAIN RESEARCH VARIABLES: 30-day mortality, postoperative complications, and tumor type. FINDINGS: The most frequent complication in the sample was gastrointestinal bleeding (13.2%); however, 37.1% of patients who died had respiratory compromise as a complication. Admission through the emergency department was significantly associated with experiencing a complication (71.9% versus 43.9%). CONCLUSIONS: Treatable but serious postoperative complications are frequent and can be fatal in the surgical oncology population. Complication frequency and fatality vary significantly by cancer type. IMPLICATIONS FOR NURSING: The complications studied are detectable by nurses and can be managed successfully with timely intervention. Recognition of complications at an early stage and evidence-based management may assist nurses in patient rescue and, ultimately, improve quality of care.
Authors: L L Leape; T A Brennan; N Laird; A G Lawthers; A R Localio; B A Barnes; L Hebert; J P Newhouse; P C Weiler; H Hiatt Journal: N Engl J Med Date: 1991-02-07 Impact factor: 91.245