Failure to Rescue: A New Society of Thoracic Surgeons Quality Metric for Cardiac Surgery.
The Annals of thoracic surgery
BACKGROUND: Failure to rescue (FTR) focuses on the ability to prevent death among patients who experience postoperative complications. The Society of Thoracic Surgeons (STS) Quality Measurement Task Force has developed a new, risk- adjusted FTR quality metric for adult cardiac surgery.
METHODS: The study population was taken from 1118 STS Adult Cardiac Surgery Database participants including patients who underwent isolated CABG, aortic valve replacement +/- CABG, or mitral valve repair/replacement, +/- CABG between January, 2015 and June, 2019. The FTR analysis was derived from patients who experienced ≥ 1 of the following complications: prolonged ventilation, stroke, reoperation, and renal failure. Data were randomly split into 70% training (n=89,059) and 30% validation samples (n=38,242),Risk variables included STS predicted risk of mortality, operative procedures, and intraoperative variables (cardiopulmonary bypass and cross-clamp times, unplanned procedures, need for circulatory support, and massive transfusion).
RESULTS: Overall mortality for the for patients undergoing any of the index operations during the study period was 2.6% (27,045/1,058,138), with mortality of 0.9% (8,316/930,837), 8.0% (7,618/94,918), 30.6% (8,247/26,934), 51.9%(2,661/5,123), and 62.3% (203/326) among patients suffering none, one, two, three or four complications. FTR risk model calibration was excellent, as were model discrimination (c-statistic 0.806) and the Brier score (0.102). Using 95% Bayesian credible intervals, 62 (5.6%) participants performed worse and 53 (4.7%) participants performed better than expected.
CONCLUSIONS: A new risk-adjusted FTR metric has been developed which complements existing STS performance measures. The metric specifically assesses institutional effectiveness of postoperative care, allowing hospitals to target quality improvement efforts.
Kurlansky, Paul A; O'Brien, Sean M; Vassileva, Christina M; Lobdell, Kevin W; Edwards, Fred H; Jacobs, Jeffrey P; von Ballmoos, Moritz Wyler; Paone, Gaetano; Edgerton, James R; Thourani, Vinod H; Furnary, Anthony P; Ferraris, Victor A; Cleveland, Joseph C; Bowdish, Michael E; Likosky, Donald S; Badhwar, Vinay; and Shahian, David M, "Failure to Rescue: A New Society of Thoracic Surgeons Quality Metric for Cardiac Surgery." (2021). Articles, Abstracts, and Reports. 5060.