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
Multicenter Study
. 2022 Oct:106:106890.
doi: 10.1016/j.ijsu.2022.106890. Epub 2022 Sep 9.

Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study

Javier Osorio  1 , Zoilo Madrazo  2 , Sebastian Videla  3 , Beatriz Sainz  4 , Araceli Rodríguez-Gonzalez  5 , Andrea Campos  6 , Maite Santamaria  7 , Amalia Pelegrina  8 , Carmen Gonzalez-Serrano  9 , Aurora Aldeano  10 , Aingeru Sarriugarte  11 , Carlos Javier Gómez-Díaz  12 , David Ruiz-Luna  13 , Amador García-Ruiz-de-Gordejuela  14 , Concepción Gomez-Gavara  15 , Marta Gil-Barrionuevo  16 , Marina Vila  17 , Arantxa Clavell  18 , Beatriz Campillo  19 , Laura Millan  20 , Carles Olona  21 , Sergi Sanchez-Cordero  22 , Rodrigo Medrano  23 , Camilo Andrés Lopez-Arevalo  24 , Noelia Pérez-Romero  25 , Eva Artigau  26 , Miguel Calle  27 , Víctor Echenagusia  28 , Aurema Otero  29 , Cristian Tebe  30 , Natàlia Pallares  30 , Sebastiano Biondo  2 , Jose Maria Valderas  31 ; COVID-CIR Collaborative Group
Affiliations
Multicenter Study

Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study

Javier Osorio et al. Int J Surg. 2022 Oct.

Abstract

Background: Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic.

Material and methods: Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March-April 2020), non-peak (May-June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay.

Results: 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27-3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0-29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01-6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31-4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27-8.00), medium-volume (OR 2.79, 95% CI 1.14-7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07-4.72).

Conclusion: FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.

Keywords: COVID-19; Emergency surgery; Failure-to-rescue; Resilience.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest The authors have no competing interests to declare.

Figures

Fig. 1
Fig. 1
Box plota for failure-to-rescue in pandemic (peak and non-peak) and calendar control periods. FTR: failure-to-rescue. a Each dot represents a hospital. Dot's area is proportional to the number of cases included by each hospital.
Fig. 2a
Fig. 2a
Failure-to-rescue propensity-score-matched comparison of pandemic vs. pre-pandemic periods across different hospital categories (including COVID-19 incidence in the reference population). Pandemic peak vs. calendar control
Fig. 2b
Fig. 2b
Failure-to-rescue propensity-score-matched comparison of pandemic vs. pre-pandemic periods across different hospital categories (including COVID-19 incidence in the reference population). Pandemic non-peak vs. calendar control. COVID-19: coronavirus disease 2019; OR: odds ratio; 95% CI: 95% confident interval.
See this image and copyright information in PMC

References

    1. Sohrabi C., Alsafi Z., O'Neill N., et al. World health organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19) Int. J. Surg. 2020;76:71–76. doi: 10.1016/j.ijsu.2020.02.034. - DOI - PMC - PubMed
    1. Nicola M., Alsafi Z., Sohrabi C., et al. The socio-economic implications of the coronavirus pandemic (COVID-19): a review. Int. J. Surg. 2020;78:185–193. doi: 10.1016/j.ijsu.2020.04.018. - DOI - PMC - PubMed
    1. García-Basteiro A., Alvarez-Dardet C., Arenas A., et al. The need for an independent evaluation of the COVID-19 response in Spain. Lancet. 2020;396:529–530. doi: 10.1016/S0140-6736(20)31713-X. - DOI - PMC - PubMed
    1. Nicola M., O'Neill N., Sohrabi C., Khan M., Agha M., Agha R. Evidence based management guideline for the COVID-19 pandemic - review article. Int. J. Surg. 2020;77:206–216. doi: 10.1016/j.ijsu.2020.04.001. - DOI - PMC - PubMed
    1. International Strategy for Disaster Reduction . World Conference on Disaster Reduction, 18–22 January 2005. Kobe, Hyogo, Japan; 2005. Hyogo framework for action 2005–2015: building the resilience of nations and communities to disasters.https://www.unisdr.org/2005/wcdr/intergover/official-doc/L-docs/Hyogo-fr... accessed.

Publication types