Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Jan;165(1):134-143.e3.
doi: 10.1016/j.jtcvs.2021.01.064. Epub 2021 Jan 29.

Interhospital failure to rescue after coronary artery bypass grafting

Donald S Likosky  1 , Raymond J Strobel  2 , Xiaoting Wu  3 , Robert S Kramer  4 , Baron L Hamman  5 , James K Brevig  6 , Michael P Thompson  3 , Amir A Ghaferi  7 , Min Zhang  8 , Eric J Lehr  9 ; National Cardiac Surgery Quality IMPROVE Network
Affiliations
Observational Study

Interhospital failure to rescue after coronary artery bypass grafting

Donald S Likosky et al. J Thorac Cardiovasc Surg. 2023 Jan.

Abstract

Objective: We evaluated whether interhospital variation in mortality rates for coronary artery bypass grafting was driven by complications and failure to rescue.

Methods: An observational study was conducted among 83,747 patients undergoing isolated coronary artery bypass grafting between July 2011 and June 2017 across 90 hospitals. Failure to rescue was defined as operative mortality among patients developing complications. Complications included the Society of Thoracic Surgeons 5 major complications (stroke, surgical reexploration, deep sternal wound infection, renal failure, prolonged intubation) and a broader set of 19 overall complications. After creating terciles of hospital performance (based on observed:expected mortality), each tercile was compared on the basis of crude rates of (1) major and overall complications, (2) operative mortality, and (3) failure to rescue (among major and overall complications). The correlation between hospital observed and expected (to address confounding) failure to rescue rates was assessed.

Results: Median Society of Thoracic Surgeons predicted mortality risk was similar across hospital observed:expected mortality terciles (P = .831). Mortality rates significantly increased across terciles (low tercile: 1.4%, high tercile: 2.8%). Although small in magnitude, rates of major (low tercile: 11.1%, high tercile: 12.2%) and overall (low tercile: 36.6%, high tercile: 35.3%) complications significantly differed across terciles. Nonetheless, failure to rescue rates increased substantially across terciles among patients with major (low tercile: 9.1%, high tercile: 14.3%) and overall (low tercile: 3.3%, high tercile: 6.8%) complications. Hospital observed and expected failure to rescue rates were positively correlated among patients with major (R2 = 0.14) and overall (R2 = 0.51) complications.

Conclusions: The reported interhospital variability in successful rescue after coronary artery bypass grafting supports the importance of identifying best practices at high-performing hospitals, including early recognition and management of complications.

Keywords: complications; coronary artery bypass grafting; mortality.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1 (A-E):
Figure 1 (A-E):. Histograms of Interhospital Variability in Complication, Mortality and Failure to Rescue Rates
Each figure is separately sorted by hospital. A: Major complications; B: Overall complications; C: Operative mortality; D: FTR among major complications; E: FTR among overall complications. Major complications included five STS-defined major morbidities. Overall complications included the STS major and 14 additional morbidities. Failure to Rescue (FTR): death among patients developing a complication.
Figure 1 (A-E):
Figure 1 (A-E):. Histograms of Interhospital Variability in Complication, Mortality and Failure to Rescue Rates
Each figure is separately sorted by hospital. A: Major complications; B: Overall complications; C: Operative mortality; D: FTR among major complications; E: FTR among overall complications. Major complications included five STS-defined major morbidities. Overall complications included the STS major and 14 additional morbidities. Failure to Rescue (FTR): death among patients developing a complication.
Figure 1 (A-E):
Figure 1 (A-E):. Histograms of Interhospital Variability in Complication, Mortality and Failure to Rescue Rates
Each figure is separately sorted by hospital. A: Major complications; B: Overall complications; C: Operative mortality; D: FTR among major complications; E: FTR among overall complications. Major complications included five STS-defined major morbidities. Overall complications included the STS major and 14 additional morbidities. Failure to Rescue (FTR): death among patients developing a complication.
Figure 1 (A-E):
Figure 1 (A-E):. Histograms of Interhospital Variability in Complication, Mortality and Failure to Rescue Rates
Each figure is separately sorted by hospital. A: Major complications; B: Overall complications; C: Operative mortality; D: FTR among major complications; E: FTR among overall complications. Major complications included five STS-defined major morbidities. Overall complications included the STS major and 14 additional morbidities. Failure to Rescue (FTR): death among patients developing a complication.
Figure 1 (A-E):
Figure 1 (A-E):. Histograms of Interhospital Variability in Complication, Mortality and Failure to Rescue Rates
Each figure is separately sorted by hospital. A: Major complications; B: Overall complications; C: Operative mortality; D: FTR among major complications; E: FTR among overall complications. Major complications included five STS-defined major morbidities. Overall complications included the STS major and 14 additional morbidities. Failure to Rescue (FTR): death among patients developing a complication.
Figure 2:
Figure 2:. Complication, Mortality and Failure to Rescue Rates by Hospital Observed:Expected Mortality Tercile<
Major complications included five STS-defined major morbidities. Overall complications included the STS major and 14 additional morbidities. Failure to Rescue: death among patients developing a complication. Expected mortality rates were calculated based on the STS mortality models. O:E -> observed:expected hospital mortality tercile
Figure 3 (A-B)
Figure 3 (A-B). Variability in Observed and Expected Failure to Rescue by Hospital:
A: Failure to rescue among major complications (five STS-defined major morbidities). B: Failure to rescue among overall complications (STS major and 14 additional morbidities). Expected values, derived from multivariable regression models, represent the expected hospital failure to rescue rate.
Figure 3 (A-B)
Figure 3 (A-B). Variability in Observed and Expected Failure to Rescue by Hospital:
A: Failure to rescue among major complications (five STS-defined major morbidities). B: Failure to rescue among overall complications (STS major and 14 additional morbidities). Expected values, derived from multivariable regression models, represent the expected hospital failure to rescue rate.
Figure 4:
Figure 4:
Interhospital variability in mortality was attributed to failure to rescue (FTR). FTR rates were higher for patients in high observed:expected (O:E) mortality tercile hospitals. Successful rescue differed by complication type and across O:E terciles. Hospital observed and expected FTR rates were correlated although weaker for major complications.
None
See this image and copyright information in PMC

Comment in

References

    1. Hospital Compare. Medicare.gov | Hospital Compare. Accessed October 16, 2020. https://www.medicare.gov/hospitalcompare/search.html?
    1. Homepage | STS. Accessed March 30, 2020. http://www.sts.org
    1. Reddy HG, Shih T, Englesbe MJ, Shannon FS, Theurer PF, Herbert MA, et al. Analyzing “failure to rescue”: is this an opportunity for outcome improvement in cardiac surgery? Ann Thorac Surg. 2013;95(6):1976–1981; discussion 1981. - PMC - PubMed
    1. Edwards FH, Ferraris VA, Kurlansky PA, Lobbdell KW, He X, O’Brien SM, et al. Failure to Rescue Rates After Coronary Artery Bypass Grafting: An Analysis From The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2016;102(2):458–464. - PubMed
    1. Shahian DM, O’Brien SM, Filardo G, Ferraris VA, Haan CK, Rich JB, et al. The Society of Thoracic Surgeons 2008 cardiac surgery risk models: part 1--coronary artery bypass grafting surgery. Ann Thorac Surg. 2009;88(1 Suppl):S2–S22. - PubMed

Publication types