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Rumalla KC, Covell MM, Skandalakis GP, Rumalla K, Kassicieh AJ, Roy JM, Kazim SF, Segura A, Bowers CA. The frailty-driven predictive model for failure to rescue among patients who experienced a major complication following cervical decompression and fusion: an ACS-NSQIP analysis of 3,632 cases (2011-2020). Spine J 2024; 24:582-589. [PMID: 38103740 DOI: 10.1016/j.spinee.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND CONTEXT Preoperative risk stratification for patients considering cervical decompression and fusion (CDF) relies on established independent risk factors to predict the probability of complications and outcomes in order to help guide pre and perioperative decision-making. PURPOSE This study aims to determine frailty's impact on failure to rescue (FTR), or when a mortality occurs within 30 days following a major complication. STUDY DESIGN/SETTING Cross-sectional retrospective analysis of retrospective and nationally-representative data. PATIENT SAMPLE The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for all CDF cases from 2011-2020. OUTCOME MEASURES CDF patients who experienced a major complication were identified and FTR was calculated as death or hospice disposition within 30 days of a major complication. METHODS Frailty was measured by the Risk Analysis Index-Revised (RAI-Rev). Baseline patient demographics and characteristics were compared for all FTR patients. Significant factors were assessed by univariate and multivariable regression for the development of a frailty-driven predictive model for FTR. The discriminative ability of the predictive model was assessed using a receiving operating characteristic (ROC) curve analysis. RESULTS There were 3632 CDF patients who suffered a major complication and 7.6% (277 patients) subsequently expired or dispositioned to hospice, the definition of FTR. Independent predictors of FTR were nonelective surgery, frailty, preoperative intubation, thrombosis or embolic complication, unplanned intubation, on ventilator for >48 hours, cardiac arrest, and septic shock. Frailty, and a combination of preoperative and postoperative risk factors in a predictive model for FTR, achieved outstanding discriminatory accuracy (C-statistic = 0.901, CI: 0.883-0.919). CONCLUSION Preoperative and postoperative risk factors, combined with frailty, yield a highly accurate predictive model for FTR in CDF patients. Our model may guide surgical management and/or prognostication regarding the likelihood of FTR after a major complication postoperatively with CDF patients. Future studies may determine the predictive ability of this model in other neurosurgical patient populations.
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Affiliation(s)
- Kranti C Rumalla
- Feinberg School of Medicine, Northwestern University, 420 E Superior St., Chicago, IL, 60611, USA
| | - Michael M Covell
- School of Medicine, Georgetown University, 3900 Reservoir Road NW, Washington, DC, 20007, USA
| | - Georgios P Skandalakis
- Department of Neurosurgery, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM, 87106, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM, 87106, USA
| | - Alexander J Kassicieh
- Department of Neurosurgery, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM, 87106, USA
| | - Joanna M Roy
- Topiwala National Medical College, Mumbai Central, Mumbai, Maharashtra 400008, India
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM, 87106, USA
| | - Aaron Segura
- Department of Neurosurgery, University of New Mexico Hospital, 2211 Lomas Blvd NE, Albuquerque, NM, 87106, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, 8342 S Levine Ln, Sandy, UT, 84070, USA.
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Roy JM, Segura AC, Rumalla K, Skandalakis GP, Covell MM, Bowers CA. A Predictive Model of Failure to Rescue After Thoracolumbar Fusion. Neurospine 2023; 20:1337-1345. [PMID: 38171301 PMCID: PMC10762394 DOI: 10.14245/ns.2346840.420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/30/2023] [Accepted: 10/01/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Although failure to rescue (FTR) has been utilized as a quality-improvement metric in several surgical specialties, its current utilization in spine surgery is limited. Our study aims to identify the patient characteristics that are independent predictors of FTR among thoracolumbar fusion (TLF) patients. METHODS Patients who underwent TLF were identified using relevant diagnostic and procedural codes from the National Surgical Quality Improvement Program (NSQIP) database from 2011-2020. Frailty was assessed using the risk analysis index (RAI). FTR was defined as death, within 30 days, following a major complication. Univariate and multivariable analyses were used to compare baseline characteristics and early postoperative sequelae across FTR and non-FTR cohorts. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory accuracy of the frailty-driven predictive model for FTR. RESULTS The study cohort (N = 15,749) had a median age of 66 years (interquartile range, 15 years). Increasing frailty, as measured by the RAI, was associated with an increased likelihood of FTR: odds ratio (95% confidence interval [CI]) is RAI 21-25, 1.3 [0.8-2.2]; RAI 26-30, 4.0 [2.4-6.6]; RAI 31-35, 7.0 [3.8-12.7]; RAI 36-40, 10.0 [4.9-20.2]; RAI 41- 45, 21.5 [9.1-50.6]; RAI ≥ 46, 45.8 [14.8-141.5]. The frailty-driven predictive model for FTR demonstrated outstanding discriminatory accuracy (C-statistic = 0.92; CI, 0.89-0.95). CONCLUSION Baseline frailty, as stratified by type of postoperative complication, predicts FTR with outstanding discriminatory accuracy in TLF patients. This frailty-driven model may inform patients and clinicians of FTR risk following TLF and help guide postoperative care after a major complication.
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Affiliation(s)
- Joanna M. Roy
- Topiwala National Medical College, Mumbai, India
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
| | - Aaron C. Segura
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Kranti Rumalla
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Georgios P. Skandalakis
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), Albuquerque, NM, USA
| | - Michael M. Covell
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Sandy, UT, USA
- School of Medicine, Georgetown University, Washington, DC, USA
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Ando T, Yamaji K, Kohsaka S, Fukutomi M, Onishi T, Inohara T, Ishii H, Amano T, Ikari Y, Tobaru T. Volume-outcome relationship in complication-related mortality after percutaneous coronary interventions: an analysis on the failure-to-rescue rate in the Japanese Nationwide Registry. Cardiovasc Interv Ther 2023; 38:388-394. [PMID: 37185925 DOI: 10.1007/s12928-023-00935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/17/2023] [Indexed: 05/17/2023]
Abstract
In-hospital mortality following percutaneous coronary intervention (PCI) varies across institutions with different annual PCI volumes. The failure to rescue (FTR) rate, defined as the mortality rate following PCI-related complications, may account for the volume-outcome relationship. The Japanese Nationwide PCI Registry, a consecutive, nationally mandated registry between 2019 and 2020, was queried. The FTR rate is defined as 'the number of patients who died following PCI-related complications' divided by 'the number of patients who experienced at least one PCI-related complication.' Multivariate analysis was used to calculate the risk-adjusted odds ratio (aOR) of the FTR rates among hospitals stratified into tertiles as low (≤ 236/year), medium (237-405/year), and high (≥ 406/year). A total of 465,716 PCIs and 1007 institutions were included. A volume-outcome relationship was observed for in-hospital mortality, and the medium-volume (aOR 0.90, 95% confidence interval [CI] 0.85-0.96), as well as high-volume (aOR 0.84, 95% CI 0.79-0.89) hospitals, had significantly lower in-hospital mortality than low-volume hospitals. Complication rates were lower at high-volume centers (1.9%, 2.2%, and 2.6% for high-, medium-, and low-volume centers, respectively; p < 0.001). The overall FTR rate was 19.0%. The FTR rates for the low-, medium-, and high-volume hospitals were 19.3%, 17.7%, and 20.6%, respectively. The medium-volume hospitals had a lower FTR rate (aOR 0.82, 95% [CI] 0.68-0.99), whereas the FTR rate was similar at the high-volume hospitals compared with that of the low-volume hospitals (aOR 1.02, 95% CI 0.83-1.26). In-hospital mortality was low after PCI in high-volume hospitals. However, the FTR rate in high-volume hospitals was not necessarily lower than that in low-volume hospitals. The FTR rate did not account for the volume-outcome relationship in PCI.
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Affiliation(s)
- Tomo Ando
- Center of Cardiovascular Disease, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai Ward, Kawasaki, Kanagawa, 212-0014, Japan.
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiovascular Medicine, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Motoki Fukutomi
- Center of Cardiovascular Disease, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai Ward, Kawasaki, Kanagawa, 212-0014, Japan
| | - Takayuki Onishi
- Center of Cardiovascular Disease, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai Ward, Kawasaki, Kanagawa, 212-0014, Japan
| | - Taku Inohara
- Department of Cardiovascular Medicine, Keio University Graduate School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Tetsuya Amano
- Department of Cardiovascular Medicine, Aichi Medical University Graduate School of Medicine, Aichi, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University Graduate School of Medicine, Isehara, Japan
| | - Tetsuya Tobaru
- Center of Cardiovascular Disease, Kawasaki Saiwai Hospital, 31-27 Omiyacho, Saiwai Ward, Kawasaki, Kanagawa, 212-0014, Japan
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Roy JM, Rumalla K, Skandalakis GP, Kazim SF, Schmidt MH, Bowers CA. Failure to rescue as a patient safety indicator for neurosurgical patients: are we there yet? A systematic review. Neurosurg Rev 2023; 46:227. [PMID: 37672166 DOI: 10.1007/s10143-023-02137-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/25/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023]
Abstract
Failure to rescue (FTR) is a standardized patient safety indicator (PSI-04) developed by the Agency for Healthcare Research and Quality (AHRQ) to assess the ability of a healthcare team to prevent mortality following a major complication. However, FTR rates vary and are impacted by non-modifiable individual patient characteristics such as baseline frailty. This raises concerns regarding the validity of FTR as an objective quality metric, as not all patients have the same baseline frailty level, or physiological reserve, to recover from major complications. Literature from other surgical specialties has identified flaws in FTR and called for risk-adjusted metrics. Currently, knowledge of factors influencing FTR and its subsequent implementation in neurosurgical patients are limited. The present review assesses trends in FTR utilization to assess how FTR performs as an objective neurosurgery quality metric. This review then proposes how FTR may be best modified to optimize use in neurosurgical patients. A PubMed search was performed to identify articles published until August 9, 2023. Studies that reported FTR as an outcome in patients undergoing neurosurgical procedures were included. A qualitative assessment was performed using the Newcastle Ottawa Scale (NOS). The initial search revealed 1232 citations. After a title and abstract screen, followed by a full text screen, 12 studies met criteria for inclusion. These articles measured FTR across a total of 764,349 patients undergoing neurosurgical procedures. Five studies analyzed FTR with regard to hospital characteristics, and three studies utilized patient characteristics to predict FTR. All studies were considered high quality based on the NOS. Modifications in criteria to measure FTR are necessary since FTR depends on patient characteristics like frailty. This would allow for the incorporation of risk-adjusted FTR metrics that would aid in clinical decision making in neurosurgical patients.
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Affiliation(s)
- Joanna M Roy
- Topiwala National Medical College, Mumbai, India
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87131, USA
| | - Kavelin Rumalla
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA
| | - Georgios P Skandalakis
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA
| | - Meic H Schmidt
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87131, USA
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA
| | - Christian A Bowers
- Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87131, USA.
- Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA.
- Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM, 81731, USA.
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Kuwabara M, Ikawa F, Michihata N, Sakamoto S, Okazaki T, Hosogai M, Maeda Y, Horie N, Kurisu K, Fushimi K, Yasunaga H. The 5-Factor Modified Frailty Index as a More Useful Associated Factor Than Chronological Age After Unruptured Cerebral Aneurysm Surgery: A Nationwide Registry Study. Neurosurgery 2023; 92:329-337. [PMID: 36331212 PMCID: PMC9815091 DOI: 10.1227/neu.0000000000002203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Although chronological age is associated with mortality and morbidity after surgery for unruptured cerebral aneurysms (UCAs), there is little evidence regarding an association between the simplified 5-factor modified frailty index (mFI-5) and postoperative outcomes based on age group. OBJECTIVE To investigate the association of the mFI-5 score with worse outcomes, mortality, and complications in patients after surgery for UCA by chronological age groups using a Japanese national database. METHODS This study included 32 902 patients with UCAs enrolled in a Japanese national database between 2011 and 2015. Age group (younger than 65 years, 65-74 years, and 75 years or older), sex, UCA location, treatment, medications, Barthel Index (BI), medical history, mFI-5 score, and in-hospital mortality and complications were evaluated. We identified risk factors for worsening BI score, in-hospital mortality, and overall postoperative complications in each age group. RESULTS In total, 14 465 patients were enrolled in this study. Multivariable analysis showed that elderly groups and patients with an mFI-5 score ≥2 items were associated with worsening BI scores (odds ratio 1.95; 95% CI 1.52-2.51) and in-hospital complications (odds ratio 1.79; CI 1.49-2.15), despite having no association with in-hospital mortality. Multivariable analysis by age groups showed that the mFI-5 score ≥2 items was associated with in-hospital complications in all age groups, unlike chronological age in patients younger than 74 years. CONCLUSION The mFI-5 score was a more useful associated factor of in-hospital complications than chronological age in patients younger than 74 years undergoing surgery for UCA.
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Affiliation(s)
- Masashi Kuwabara
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shigeyuki Sakamoto
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takahito Okazaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Hosogai
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuyo Maeda
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
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Ikawa F, Michihata N, Oya S, Hidaka T, Ohata K, Saito K, Yoshida K, Fushimi K, Yasunaga H, Tominaga T, Kurisu K, Horie N. A nationwide registry study: The 5-factor modified frailty index of meningioma surgery in non-elderly and elderly patients. Clin Neurol Neurosurg 2022; 222:107445. [PMID: 36174406 DOI: 10.1016/j.clineuro.2022.107445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/20/2022] [Accepted: 09/08/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The simplified 5-factor modified frailty index (mFI-5) is a useful indicator of outcome for patients undergoing surgeries as frailty is considered an important risk factor in elderly patients. However, its usefulness has not been validated based on age groups. Therefore, we aimed to investigate risk factors, including the mFI-5, across age groups for complications and worse outcomes in meningioma surgery using data obtained from the nationwide database in Japan. METHODS We extracted data from the nationwide registry database in Japan between 2010 and 2015. Age (< 65, 65-74, and ≥ 75 years), sex, Barthel Index (BI), mFI-5 scores, and complications were evaluated. Multivariate logistic regression analyses identified risk factors for worsening BI scores and complications after surgery across all age groups. RESULTS Among 8138 included patients, an mFI-5 score ≥ 2 items was a significant risk factor for worsening BI scores in patients aged < 65 years (odds ratio: 2.3; 95 % confidence interval: 1.5-3.4), but not in patients aged 65-74 years and those aged ≥ 75 years, contrary to chronological age. Similar results were noted for any complications in patients aged < 65 years (2.5; 1.8-3.6) and aged 65-74 years (1.5; 1.1-2.1), but not in patients aged ≥ 75 years. CONCLUSION Although the mFI-5 scores could predict the risk of in-hospital worsening outcomes, mortality, and complications, it was more useful in non-elderly patients aged < 65 years rather than in elderly patients aged ≥ 75 years, contrary to chronological age. Further prospective studies should be performed in the future to clarify the utility of the mFI-5.
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Affiliation(s)
- Fusao Ikawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan.
| | - Nobuaki Michihata
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Soichi Oya
- Department of Neurosurgery, Saitama Medical Center, Saitama, Japan
| | - Toshikazu Hidaka
- Department of Neurosurgery, Shimane Prefectural Central Hospital, Izumo, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Saito
- Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan
| | - Kazunari Yoshida
- Department of Neurosurgery, Keio University School of Medicine, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Montero Ruiz E, Rubal Bran D. Which surgical patients require shared care? Rev Clin Esp 2020; 220:578-582. [PMID: 32534805 DOI: 10.1016/j.rce.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 11/18/2022]
Abstract
Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC.
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Affiliation(s)
- E Montero Ruiz
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - D Rubal Bran
- Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, España
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8
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Montero Ruiz E, Rubal Bran D. Which surgical patients require shared care? Rev Clin Esp 2020. [DOI: 10.1016/j.rceng.2020.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Osho AA, Bishawi MM, Heng EE, Orubu E, Amardey-Wellington A, Villavicencio MA, Funamoto M. Failure to rescue in the era of the lung allocation score: The impact of center volume. Am J Surg 2020; 220:793-799. [PMID: 31982094 DOI: 10.1016/j.amjsurg.2020.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 12/28/2019] [Accepted: 01/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Failure to Rescue (FTR) is a valuable surgical quality improvement metric. The aim of this study is to assess the relationship between center volume and FTR following lung transplantation. METHODS Using the database of the United Network for Organ Sharing (UNOS) all adult, primary, isolated lung recipients in the United States between May 2005 and March 2016 were identified. FTR was defined as operative mortality after any of five specific complications. FTR was compared across terciles of transplantation centers stratified based on operative volume. RESULTS 17,185 lung recipients met study criteria. The composite FTR rate (Death following at least one complication) was 20.7%. Following stratification by volume, FTR rates increased from high to middle tercile centers (19.3% vs. 23.0%). Multivariate logistic regression models suggested an independent relationship between higher center volume and lower FTR rates (p < 0.001). CONCLUSION Higher volume lung transplantation centers have lower rates of failure to rescue.
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Affiliation(s)
- Asishana A Osho
- Massachusetts General Hospital, Cardiac Surgery, Cox 6, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Muath M Bishawi
- Duke University Medical Center, Thoracic Surgery, DUMC Box 3496, Durham, NC, 27710, USA
| | - Elbert E Heng
- Massachusetts General Hospital, Cardiac Surgery, Cox 6, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ejiro Orubu
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Masaki Funamoto
- Massachusetts General Hospital, Cardiac Surgery, Cox 6, 55 Fruit Street, Boston, MA, 02114, USA
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Luther EM, McCarthy D, Berry KM, Rajulapati N, Shah AH, Eichberg DG, Komotar RJ, Ivan M. Hospital teaching status associated with reduced inpatient mortality and perioperative complications in surgical neuro-oncology. J Neurooncol 2020; 146:389-396. [PMID: 31939029 DOI: 10.1007/s11060-020-03395-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Studies have demonstrated that higher surgical volumes correlate with improved neurosurgical outcomes yet none exist evaluating the effects of hospital teaching status on the surgical neuro-oncology patient. We present the first analysis comparing brain tumor surgery perioperative outcomes at academic and non-teaching centers. METHODS Brain tumor surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. A teaching hospital, defined by the NIS, must have ≥ 1 Accreditation Council of Graduate Medical Education (ACGME) approved residency programs, Council of Teaching Hospitals membership, or have a ratio ≥ 0.25 of full-time residents to hospital beds. Annual treatment trends were stratified by hospital teaching status, assessing yearly caseload with linear regression. Multivariable logistic regression determined predictors of inpatient mortality/complications. Hospitals were further divided into quartiles by case volume and teaching status was compared in each. RESULTS Teaching hospitals (THs) exhibited an average annual increase in brain tumor surgeries (+ 1057/year, p < 0.0001). In multivariable analysis, teaching status was associated with decreased risk of mortality (OR 0.82, p = 0.0003) and increased likelihood of discharge home (OR 1.21, p < 0.0001). In subgroup analysis, within the highest hospital quartile by caseload, higher mortality rates and lower routine discharges were again seen at non-teaching hospitals (NTHs) (p = 0.0002 and p = 0.0016, respectively). CONCLUSION THs are performing more brain tumor surgeries over time with lower rates of inpatient mortality and perioperative complications even after controlling for hospital case volume. These results suggest a shift in neuro-oncology practice patterns favoring THs to optimize patient outcomes especially at the highest volume centers.
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Affiliation(s)
- Evan M Luther
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA.
| | - David McCarthy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Katherine M Berry
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Nikhil Rajulapati
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Ashish H Shah
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Daniel G Eichberg
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA
| | - Ricardo J Komotar
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Health System, 1475 NW 12th Avenue, Miami, FL, 33136, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope Life Center, 2nd floor, 1095 NW 14th Terrace, Miami, FL, 33136, USA.,Sylvester Comprehensive Cancer Center, University of Miami Health System, 1475 NW 12th Avenue, Miami, FL, 33136, USA
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11
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Osho AA, Bishawi MM, Mulvihill MS, Axtell AL, Hirji SA, Spencer PJ, Heng EE, D'Alessandro DA, Melnitchouk S, Hartwig MG, Villavicencio MA. Failure to Rescue Contributes to Center-Level Differences in Mortality After Lung Transplantation. Ann Thorac Surg 2019; 109:218-224. [PMID: 31470009 DOI: 10.1016/j.athoracsur.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical response to postoperative complications after lung transplantation (LTx) may contribute to mortality differences among transplantation centers. The ability to avoid mortality after a complication-failure to rescue (FTR)-may be an effective quality metric in LTx. METHODS The United Network for Organ Sharing database was queried for adult, first-time, lung-only transplantations from May 2005 to December 2015. Transplantation centers were stratified into equal-sized terciles on the basis of observed operative mortality rates. Several postoperative complications were identified, including stroke, acute rejection, acute kidney injury requiring hemodialysis, airway dehiscence, and extracorporeal membrane oxygenation 72 hours after surgery. Rates of FTR were calculated as the number of operative mortalities in patients who had complications divided by the number of patients who had any postoperative complications. RESULTS Our study population included 16,411 LTx operations performed at 69 transplantation centers. LTx centers were stratified into terciles with average perioperative mortality of 4.0% for low-mortality centers, 6.9% for intermediate-mortality centers, and 12.4% for high-mortality centers. Low-mortality centers had slightly lower complication rates (low, 15.0% vs intermediate, 17.1% vs high, 19.1%; P < .001). Differences in FTR rate were significantly more pronounced (low, 14.9% vs intermediate, 23.9% vs high, 34.2%; P < .001). Multivariable logistic regression and generalized linear models demonstrated an independent association between high FTR rates and high mortality in LTx (P < .001). CONCLUSIONS Differences in rates of FTR contribute significantly to per-center variability in mortality after LTx. FTR can serve as a quality metric to identify opportunities for improvement in management of perioperative adverse events.
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Affiliation(s)
- Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Muath M Bishawi
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Michael S Mulvihill
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Andrea L Axtell
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sameer A Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Philip J Spencer
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Elbert E Heng
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - David A D'Alessandro
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew G Hartwig
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, North Carolina
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12
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Andresen NS, Gourin CG, Stewart CM, Sun DQ. Hospital volume and failure to rescue after vestibular schwannoma resection. Laryngoscope 2019; 130:1287-1293. [PMID: 31268580 DOI: 10.1002/lary.28174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/05/2019] [Accepted: 06/18/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Complication rates in many complex surgical procedures are associated with the volume of procedures performed. OBJECTIVES To investigate the relationship between hospital volume and complications, mortality, and failure to rescue (FTR) rates in patients undergoing vestibular schwannoma (VS) surgery. DESIGN, SETTING, AND PARTICIPANTS The Nationwide Inpatient Sample was used to identify 44,336 patients who underwent VS surgery in 1995-2011. Annual case volumes were stratified by quintiles and defined as very low (≤5 cases/year), low (6-12 cases/year) medium (13-22 cases/year), high (23-37 cases/year), and very high-volume (≥38 cases/year). MAIN OUTCOMES AND MEASURES Relationships between hospital volume and in-hospital mortality, postoperative complications, as well as FTR rates, defined as death after a major complication, were examined using multivariate regression analysis. RESULTS Postoperative medical and surgical complications occurred in 5.4% and 14.6% of cases, respectively, and did not differ significantly across volume quintiles. In-hospital mortality decreased with increasing hospital volume, with an incidence of 1.4% for hospitals in the lowest volume quintile compared to 0.1% for hospitals in the top volume quintile. After controlling for all other variables, the odds of in-hospital mortality were lower for medium (OR = 0.19 [0.04-0.93]) and very high-volume hospitals (OR = 0.07 [0.01-0.53]), but not high-volume hospitals (OR = 0.43 [0.05-3.77]). There was no association between hospital volume and the odds of postoperative surgical complications. FTR was associated with hospital volume, with decreasing odds for medium-volume (OR = 0.15 [0.02-0.93]), high-volume (OR = 0.17 [0.04-0.74]), and very high-volume (OR = 0.07 [0.04-0.74]) hospitals. CONCLUSIONS Hospital volume does not appear to be associated with complication rates but is associated with decreased likelihood of FTR after VS surgery. LEVEL OF EVIDENCE NA Laryngoscope, 130:1287-1293, 2020.
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Affiliation(s)
- Nicholas S Andresen
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - C Matthew Stewart
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A.,Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
| | - Daniel Q Sun
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, U.S.A
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13
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Goel NJ, Mallela AN, Agarwal P, Abdullah KG, Choudhri OA, Kung DK, Lucas TH, Isaac Chen H. Complications Predicting Perioperative Mortality in Patients Undergoing Elective Craniotomy: A Population-Based Study. World Neurosurg 2018; 118:e195-e205. [DOI: 10.1016/j.wneu.2018.06.153] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/26/2022]
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Youngerman BE, Bruce JN. Capturing Quality: The Challenge for High-Volume Academic Medical Centers. Mayo Clin Proc 2018; 93:4-6. [PMID: 29304920 DOI: 10.1016/j.mayocp.2017.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Brett E Youngerman
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY
| | - Jeffrey N Bruce
- Department of Neurological Surgery, Columbia University Medical Center, New York, NY.
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