@article{d218b130282d4f36b40de89f1f469f00,
title = "Failure to Rescue – a Closer Look at Mortality Rates Has No Added Value for Hospital Comparisons but Is Useful for Team Quality Assessment in Abdominal Aortic Aneurysm Surgery in The Netherlands",
abstract = "Objectives: Failure to rescue (FTR) is a composite quality indicator, defined as the proportion of deceased patients following major complications. The aims of this study were to compare FTR with mortality for hospital comparisons in abdominal aortic aneurysm (AAA) surgery in The Netherlands and investigate hospital volume and associated factors.Methods: Patients prospectively registered between 2013 and 2015 in the Dutch Surgical Aneurysm Audit (DSAA) were analysed. FTR was analysed for AAA patients and subgroups elective (EAAA) and acute (AAAA; symptomatic or ruptured) aneurysms. Variables and hospital volume were analysed by uni- and multivariable regression analysis. Adjusted hospital comparisons for mortality, major complications, and FTR were presented in funnel plots. Isomortality lines were constructed when presenting FTR and major complication rates.Results: A total of 9258 patients were analysed in 61 hospitals: 7149 EAAA patients (77.2%) and 2109 AAAA patients (22.8%). There were 2785 (30.1%) patients with complications (unadjusted range 5–65% per hospital): 2161 (77.6%) with major and 624 (28.4%) patients with minor complications. Overall mortality was 6.6% (adjusted range 0–16% per hospital) and FTR was 28.4% (n = 613) (adjusted range 0–60% per hospital). Glasgow Coma Scale, age, pulse, creatinine, electrocardiography, and operative setting were independently associated with FTR. Hospital volume was not associated with FTR. In AAAA patients hospital volume was significantly associated with a lower adjusted major complication and mortality rate (OR 0.62, 95% CI 0.49–0.78; and 0.64, 95% CI 0.48–0.87). Four hospitals had a significant lower adjusted FTR with different major complication rates on different isomortality lines.Conclusions: There was more variation in FTR than in mortality between hospitals. FTR identified the same best performing hospitals as for mortality and therefore was of limited additional value in measuring quality of care for AAA surgery. FTR can be used for internal quality improvement with major complications in funnel plots and diagrams with isomortality lines.",
keywords = "Abdominal aortic aneurysm, Clinical audit, Composite outcome measures, Failure to rescue, Surgical outcome",
author = "{the Dutch Society of Vascular Surgery} and {the Steering Committee of the Dutch Surgical Aneurysm Audit} and {the Dutch Institute for Clinical Auditing} and {Van den Akker}, {L. H.} and Arts, {C. H.} and Bakker, {O. J.} and {van den Berg}, M. and P. Berger and Bleker, {R. J.} and Bodegom, {M. E.} and J. Bosma and Bouwman, {L. H.} and {de Bruijn}, {M. T.} and {de Bruin}, {J. L.} and Dijkema, {A. R.} and {van Doorn}, {R. C.} and Elshof, {J. W.} and {van Engeland}, {M. I.} and Faber, {M. J.} and Fritschy, {W. M.} and {de Groot}, {H. G.} and {de Haan}, {E. F.} and Helleman, {J. N.} and Hendriks, {J. M.} and Hollander, {E. J.} and Huisman, {L. C.} and Jacobs, {M. J.} and Janssen, {R. J.} and Jiang, {H. H.} and {de Jong}, {S. C.} and {Khodadade Jahrome}, A. and B. Knippenberg and Kolkert, {J. L.} and Koning, {G. G.} and Krol, {R. M.} and Kruse, {R. R.} and {van der Laan}, L. and {van der Laan}, {M. J.} and Lind, {R. C.} and {Liqui Lung}, {P. F.} and Loos, {M. J.} and W. Mulder and Nederhoed, {J. H.} and Nieuwenhuis, {D. H.} and Petri, {B. J.} and Pol, {R. A.} and {van Rijn}, {M. J.} and Saleem, {B. R.} and {van Schaik}, J. and {van Schaik}, {P. M.} and Scheltinga, {M. R.} and Smeets, {H. J.} and L. Smeets and {de Smet}, {A. A.} and Smit, {P. C.} and Smits, {T. M.} and H. Stigter and Tielliu, {I. F.} and Veen, {E. J.} and Veldman, {M. G.} and Verhoeven, {B. A.} and Vermeulen, {C. F.} and Vermeulen, {E. G.} and Vierhout, {B. P.} and Visser, {M. J.} and Voesten, {H. G.} and Vos, {A. W.} and {de Vos}, B. and Vos, {G. A.} and {de Vries}, {A. C.} and {de Vries}, {J. P.} and {de Vries}, M. and {van Walraven}, {L. A.} and Wever, {J. J.} and Wiersema, {A. M.} and Willems, {M. C.} and Witte, {M. E.} and Zeebregts, {C. J.} and {Van den Akker}, {L. H.} and {Van den Akker}, {P. J.} and Arts, {C. H.} and Bakker, {O. J.} and {van den Berg}, M. and P. Berger and Bleker, {R. J.} and Bodegom, {M. E.} and J. Bosma and Bouwman, {L. H.} and {de Bruijn}, {M. T.} and {de Bruin}, {J. L.} and Dijkema, {A. R.} and {van Doorn}, {R. C.} and Elshof, {J. W.} and {van Engeland}, {M. I.} and Faber, {M. J.} and Fritschy, {W. M.} and {de Groot}, {H. G.} and {de Haan}, {E. F.} and Hazenberg, {C. E.} and Helleman, {J. N.} and Hendriks, {J. M.} and Hollander, {E. J.} and Huisman, {L. C.} and Jacobs, {M. J.} and Janssen, {R. J.} and Jiang, {H. H.} and {de Jong}, {S. C.} and {Khodadade Jahrome}, A. and B. Knippenberg and Kolkert, {J. L.} and Koning, {G. G.} and Krol, {R. M.} and Kruse, {R. R.} and {van der Laan}, L. and Lind, {R. C.} and {Liqui Lung}, {P. F.} and Loos, {M. J.} and W. Mulder and Nederhoed, {J. H.} and Nieuwenhuis, {D. H.} and Petri, {B. J.} and Pol, {R. A.} and {van Rijn}, {M. J.} and Saleem, {B. R.} and {van Schaik}, J. and {van Schaik}, {P. M.} and Scheltinga, {M. R.} and Smeets, {H. J.} and L. Smeets and {de Smet}, {A. A.} and Smit, {P. C.} and Smits, {T. M.} and H. Stigter and Tielliu, {I. F.} and Veen, {E. J.} and Veldman, {M. G.} and Verhoeven, {B. A.} and Vermeulen, {C. F.} and Vermeulen, {E. G.} and Vierhout, {B. P.} and Visser, {M. J.} and Voesten, {H. G.} and Vos, {A. W.} and {de Vos}, B. and Vos, {G. A.} and {de Vries}, {A. C.} and {de Vries}, {J. P.} and {de Vries}, M. and {van Walraven}, {L. A.} and Wever, {J. J.} and Wiersema, {A. M.} and Willems, {M. C.} and Witte, {M. E.} and Niki Lijftogt and Karthaus, {Eleonora G.} and Anco Vahl and {Van Zwet}, {Erik W.} and {Van Der Willik}, {Esmee M.} and RAEM Tollenaar and Hamming, {Jaap F.} and Wouters, {Michel W. J. M.}",
note = "Funding Information: The authors would like to thank the members of the Dutch Society for Vascular Surgery who registered their patients in the DSAA, the Dutch Institute for Clinical Auditing that facilitated the registry and the Dutch Surgical Aneurysm Audit group. Publisher Copyright: {\textcopyright} 2018 European Society for Vascular Surgery",
year = "2018",
month = nov,
day = "1",
doi = "10.1016/j.ejvs.2018.06.062",
language = "English",
volume = "56",
pages = "652--661",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W B SAUNDERS CO LTD",
number = "5",
}