Trauma/Critical CareFactors associated with failure-to-rescue in patients undergoing trauma laparotomy
Section snippets
Study settings and patients
After obtaining approval from the Institutional Review Board at the University of Arizona, College of Medicine, we performed an 8-year (2006–2013), retrospective cohort analysis of all trauma patients who underwent laparotomy at our level 1 trauma center. Patients with intra-abdominal injuries who underwent emergent laparotomies and developed major complications postoperatively were included. We excluded the patients who died in the first 24 hours of hospital admission.
Data points and definitions
Patient's medical records
Results
A total of 1,029 patients were reviewed, of which 21% (n = 217) who developed major complications were included. The flow of patients in our study is shown in Fig 1. The mean age was 39 ± 18 years, 82% were male, 61% had blunt trauma, and median abdominal abbreviated injury scale was 25 [16–34]. Trauma and injury severity score (predicted survival probability) was 80.9%, and actual survival rate was 84.3% in our patient cohort. Patient demographics are summarized in Table I.
Respiratory
Discussion
FTR defined as death after a major in-hospital complication seems to be a very sensitive quality of care indicator compared with hospital complication rates, which is not strongly correlated with mortality. Although programs like the Trauma Quality Improvement Program aim to identify best practices, patient-level factors that affect the FTR rate are poorly understood. We found that patients' insurance, age, severity of head injury, as well as prolonged resuscitation with blood products were
References (30)
- et al.
The Trauma Quality Improvement Program of the American College of Surgeons Committee on Trauma
J Am Coll Surg
(2009) - et al.
The association of intensivists with failure-to-rescue rates in outlier hospitals: results of a national survey of intensive care unit organizational characteristics
J Crit Care
(2014) - et al.
The impact of insurance and socioeconomic status on outcomes for patients with left ventricular assist devices
J Surg Res
(2014) - et al.
Mechanism of injury predicts patient mortality and impairment after blunt trauma
J Surg Res
(2009) - et al.
Mortality after trauma laparotomy in geriatric patients
J Surg Res
(2014) - et al.
Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis
J Am Coll Surg
(2014) - et al.
The Trauma Quality Improvement Program: pilot study and initial demonstration of feasibility
J Trauma
(2010) - et al.
Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization
JAMA
(2003) - et al.
Changes in prognosis after the first postoperative complication
Med Care
(2005) - et al.
A spurious correlation between hospital mortality and complication rates: the importance of severity adjustment
Med Care
(1997)
Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery
JAMA
Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients
Ann Surg
Variation in hospital mortality associated with inpatient surgery
N Engl J Med
Prevention of complications and successful rescue of patients with serious complications: characteristics of high-performing trauma centers
J Trauma
Variation in hospital complication rates and failure-to-rescue for trauma patients
Ann Surg
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Outcomes by time-to-OR for penetrating abdominal trauma patients
2024, American Journal of Emergency MedicineValidation of prolonged length of stay as a reliable measure of failure to rescue in colorectal surgery
2023, Asian Journal of SurgeryInterhospital failure to rescue after coronary artery bypass grafting
2023, Journal of Thoracic and Cardiovascular SurgeryPulmonary complications in trauma: Another bellwether for failure to rescue?
2021, Surgery (United States)Citation Excerpt :The identification of such hospital features could illuminate a pathway to reduced institutional mortality. Robust study of FTR has led to application of the metric to a variety of specific diseases and patient populations, including trauma.3-17 FTR is traditionally measured by evaluating overall major complications and overall death in the same cohort.
Number and Type of Complications Associated With Failure to Rescue in Trauma Patients
2020, Journal of Surgical Research