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Failure-to-rescue rates following lung resection greater at high-mortality hospitals
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High-mortality hospitals had greater failure-to-rescue rates following lung cancer resection, according to the results of a retrospective cohort study.
“There are wide variations in mortality rates across hospitals performing lung cancer resections,” Tyler R. Grenda, MD, a resident in the department of surgery at University of Michigan, told HemOnc Today. “The main purpose for this study was to better understand the factors underlying differences in mortality rates for hospitals performing lung cancer resection.”
Tyler Grenda
Grenda and colleagues ranked 1,279 hospitals accredited by the Commission on Cancer on a composite measure of risk-adjusted mortality following major cancer resections between 2005 and 2006.
The study included data from 645 patients who underwent lung cancer resections performed at 18 low-mortality hospitals (LMH; n = 441) and 25 high-mortality hospitals (HMH; n = 204). After adjusting for patient characteristics, the researchers used hierarchical logistic regression to examine differences in the incidence of complications and failure-to-rescue rates, which they defined as death following a complication.
Among the entire study cohort, LMHs had an overall unadjusted mortality rate of 1.6% (n = 7), whereas HMHs at a mortality rate of 10.8% (n = 22; P < .001). The differences in mortality rates remained significant following risk adjustment (1.8% vs. 8.1%; P < .001).
HMHs had higher overall complication rates (23.3% vs. 15.6%; adjusted OR [aOR] = 1.79; 95% CI, 0.99-3.21); however, the difference did not reach statistical significance. LHMs and HMHs had similar likelihoods of any surgical (aOR = 0.73; 95% CI, 0.26-2) or cardiopulmonary (aOR = 1.23; 95% CI, 0.7-2.16) complications.
However, significantly greater failure-to-rescue rates occurred at HMHs (25.9% vs. 8.7%; aOR = 6.55; 95% CI, 1.44-29.88).
The researchers acknowledged the inclusion of hospitals only accredited by the Commission on Cancer and the sampling of accredited hospitals only with the highest and lowest mortality rates may be limitations to these findings. Further, they acknowledged that health care and surgical practices may have changed since the time of the study.
“Further investigation is needed to better understand the main factors related to the development of complications with a focus on their subsequent management,” Grenda said. “We need to improve our understanding of why there are differences in rates of failure-to-rescue.”
Analyzing failure-to-rescue data should become standard practice for hospitals trying to reduce surgical complication rates, Thomas K. Varghese, Jr., MD, MS, associate professor of surgery at University of Utah School of Medicine, wrote in an accompanying editorial.
“Although it is important to use evidence-based measures to prevent complications, the difference in mortality for surgical procedures in the present day is often related to what hospital systems do after complication occurs,” Varghese wrote. “Actions matter, not a special hospital designation or surgeon specialty certification. Both a better understanding of factors related to complications and their management will have the biggest effect on quality improvement. Endorsed by the National Quality Forum and Agency for Healthcare Research and Quality, failure-to-rescue assessment should become the norm for all procedures because of its focus on hospital actions identifying complications quickly and treating them aggressively.” – by Cameron Kelsall
For more information:
Tyler R. Grenda, MD, can be reached at University of Michigan’s Center for Healthcare Outcomes and Policy, 2800 Plymouth Road, Building 16, Room 016-100N-12, Ann Arbor, MI 48109; email: tgrenda@med.umich.edu.
Disclosure: Grenda reports no relevant financial disclosures. One study researcher reports ownership interest in and a consultant role with ArborMetrix Inc., a health care analytics and information technology firm. Varghese reports no relevant financial disclosures.
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