Fred H Edwards1, Victor A Ferraris2, Paul A Kurlansky3, Kevin W Lobdell4, Xia He5, Sean M O'Brien5, Anthony P Furnary6, J Scott Rankin7, Christina M Vassileva8, Frank L Fazzalari9, Mitchell J Magee10, Vinay Badhwar11, Ying Xian5, Jeffrey P Jacobs12, Moritz C Wyler von Ballmoos13, David M Shahian14. 1. Department of Surgery, University of Florida, Jacksonville, Florida. Electronic address: fred.edwards@jax.ufl.edu. 2. Department of Surgery, University of Kentucky, Lexington, Kentucky. 3. College of Physicians and Surgeons, Columbia University, New York, New York. 4. Sanger Heart and Vascular Institute, Carolinas Healthcare System, Charlotte, North Carolina. 5. Duke Clinical Research Institute, Durham, North Carolina. 6. Starr-Wood Cardiac Group, Portland, Oregon. 7. Cardiothoracic Surgery Associates, Nashville, Tennessee. 8. Department of Surgery, Southern Illinois University, Springfield, Illinois. 9. Section of Cardiac Surgery, University of Michigan, Rochester, Michigan. 10. Department of Surgery, Baylor University Medical Center, Dallas, Texas. 11. Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania. 12. Johns Hopkins All Children's Heart Institute, Saint Petersburg, Florida. 13. Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin. 14. Department of Surgery/Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Failure to rescue (FTR) is increasingly recognized as an important quality indicator in surgery. The Society of Thoracic Surgeons National Database was used to develop FTR metrics and a predictive FTR model for coronary artery bypass grafting (CABG). METHODS: The study included 604,154 patients undergoing isolated CABG at 1,105 centers from January 2010 to January 2014. FTR was defined as death after four complications: stroke, renal failure, reoperation, and prolonged ventilation. FTR was determined for each complication and a composite of the four complications. A statistical model to predict FTR was developed. RESULTS: FTR rates were 22.3% for renal failure, 16.4% for stroke, 12.4% for reoperation, 12.1% for prolonged ventilation, and 10.5% for the composite. Mortality increased with multiple complications and with specific combinations of complications. The multivariate risk model for prediction of FTR demonstrated a C index of 0.792 and was well calibrated, with a 1.0% average difference between observed/expected (O/E) FTR rates. With centers grouped into mortality terciles, complication rates increased modestly (11.4% to 15.7%), but FTR rates more than doubled (6.8% to 13.9%) from the lowest to highest terciles. Centers in the lowest complication rate tercile had an FTR O/E of 1.14, whereas centers in the highest complication rate tercile had an FTR O/E of 0.91. CONCLUSIONS: CABG mortality rates vary directly with FTR, but complication rates have little relation to death. FTR rates derived from The Society of Thoracic Surgeons data can serve as national benchmarks. Predicted FTR rates may facilitate patient counseling, and FTR O/E ratios have promise as valuable quality metrics.
BACKGROUND: Failure to rescue (FTR) is increasingly recognized as an important quality indicator in surgery. The Society of Thoracic Surgeons National Database was used to develop FTR metrics and a predictive FTR model for coronary artery bypass grafting (CABG). METHODS: The study included 604,154 patients undergoing isolated CABG at 1,105 centers from January 2010 to January 2014. FTR was defined as death after four complications: stroke, renal failure, reoperation, and prolonged ventilation. FTR was determined for each complication and a composite of the four complications. A statistical model to predict FTR was developed. RESULTS: FTR rates were 22.3% for renal failure, 16.4% for stroke, 12.4% for reoperation, 12.1% for prolonged ventilation, and 10.5% for the composite. Mortality increased with multiple complications and with specific combinations of complications. The multivariate risk model for prediction of FTR demonstrated a C index of 0.792 and was well calibrated, with a 1.0% average difference between observed/expected (O/E) FTR rates. With centers grouped into mortality terciles, complication rates increased modestly (11.4% to 15.7%), but FTR rates more than doubled (6.8% to 13.9%) from the lowest to highest terciles. Centers in the lowest complication rate tercile had an FTR O/E of 1.14, whereas centers in the highest complication rate tercile had an FTR O/E of 0.91. CONCLUSIONS: CABG mortality rates vary directly with FTR, but complication rates have little relation to death. FTR rates derived from The Society of Thoracic Surgeons data can serve as national benchmarks. Predicted FTR rates may facilitate patient counseling, and FTR O/E ratios have promise as valuable quality metrics.
Authors: Michael J Pienta; Thomas M Cascino; Donald S Likosky; Amir A Ghaferi; Keith D Aaronson; Francis D Pagani; Michael P Thompson Journal: J Thorac Cardiovasc Surg Date: 2021-11-09 Impact factor: 6.439
Authors: Kevin W Lobdell; Devin M Parker; Donald S Likosky; Michael Rezaee; Moritz Wyler von Ballmoos; Shama S Alam; Sherry Owens; Heather Thiessen-Philbrook; Todd MacKenzie; Jeremiah R Brown Journal: J Thorac Cardiovasc Surg Date: 2018-04-11 Impact factor: 5.209
Authors: Robert B Hawkins; Matthew Byler; Clifford Fonner; Irving L Kron; Leora T Yarboro; Alan M Speir; Mohammed A Quader; Gorav Ailawadi; J Hunter Mehaffey Journal: J Card Surg Date: 2019-08-02 Impact factor: 1.620
Authors: Bradford B Smith; William J Mauermann; Suraj M Yalamuri; Ryan D Frank; Carmelina Gurrieri; Arman Arghami; Mark M Smith Journal: Ann Thorac Surg Date: 2020-03-07 Impact factor: 4.330
Authors: Donald S Likosky; Raymond J Strobel; Xiaoting Wu; Robert S Kramer; Baron L Hamman; James K Brevig; Michael P Thompson; Amir A Ghaferi; Min Zhang; Eric J Lehr Journal: J Thorac Cardiovasc Surg Date: 2021-01-29 Impact factor: 6.439
Authors: Alexander A Brescia; Joceline V Vu; Chang He; Jun Li; Steven D Harrington; Michael P Thompson; Edward C Norton; Scott E Regenbogen; John D Syrjamaki; Richard L Prager; Donald S Likosky Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-12
Authors: Mario Gaudino; Dominick J Angiolillo; Antonino Di Franco; Davide Capodanno; Faisal Bakaeen; Michael E Farkouh; Stephen E Fremes; David Holmes; Leonard N Girardi; Sunao Nakamura; Stuart J Head; Seung-Jung Park; Michael Mack; Patrick W Serruys; Marc Ruel; Gregg W Stone; Derrick Y Tam; Michael Vallely; David P Taggart Journal: J Am Heart Assoc Date: 2019-06-27 Impact factor: 5.501