Division of Cardiac Surgery, Department of Surgery, Western University and London Health Sciences Centre, London, Ontario, Canada; Cardiac Surgery Recovery Unit, Western University, London Health Sciences Centre, London, Ontario, Canada.
Cardiac Surgery Recovery Unit, Western University, London Health Sciences Centre, London, Ontario, Canada; Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada.
Ann Thorac Surg. 2014 Jan;97(1):147-52. doi: 10.1016/j.athoracsur.2013.07.097. Epub 2013 Oct 1.
Failure to rescue, which is defined as the probability of death after a complication that was not present on admission, was introduced as a quality measure in the 1990s, to complement mortality and morbidity outcomes. The objective of this study was to evaluate possible incremental benefits of measuring failure to rescue after cardiac surgery, to facilitate quality improvement efforts.
Data were collected prospectively on 4,978 consecutive patients who underwent cardiac operations during a 5-year period. Institutional logistic regression models were used to generate predicted rates of mortality and major complications. Frequency distributions of morbidities were determined, and failure to rescue was calculated. The annual failure-to-rescue rates were contrasted using χ(2) tests and compared with morbidity and mortality measures.
The overall mortality rate was 3.6%, the total complication rate was 16.8%, and the failure-to-rescue rate was 19.8% (95% confidence interval, 17.1% to 22.7%). The predicted risk of mortality and of major complications increased during the last 2 years of the study, whereas the observed complication rate decreased. Failure to rescue for new renal failure was the highest of all complications (48.4%), followed by septicemia (42.6%). Despite the decreased complication rate toward the end of the study, the failure-to-rescue rate did not change significantly (p = 0.28).
Failure to rescue should be monitored as a quality-of-care metric, in addition to mortality and complication rates. Postoperative renal failure and septicemia still have a high failure-to-rescue rate and should be targeted by quality improvement efforts.
未能抢救（定义为入院时不存在但随后出现的并发症导致的死亡率）作为一种质量指标于 20 世纪 90 年代引入，旨在补充死亡率和发病率结果。本研究的目的是评估在心脏手术后测量未能抢救的可能增量收益，以促进质量改进工作。
在 5 年期间前瞻性收集了 4978 例连续接受心脏手术的患者的数据。使用机构逻辑回归模型生成死亡率和主要并发症的预测率。确定发病率的频率分布，并计算未能抢救的情况。使用 χ(2)检验对比每年的未能抢救率，并与发病率和死亡率进行比较。
总体死亡率为 3.6%，总并发症发生率为 16.8%，未能抢救率为 19.8%（95%置信区间，17.1%至 22.7%）。在研究的最后 2 年，预测的死亡率和主要并发症风险增加，而观察到的并发症发生率下降。所有并发症中，新发肾衰竭的未能抢救率最高（48.4%），其次是败血症（42.6%）。尽管研究结束时并发症发生率下降，但未能抢救率并未显著变化（p=0.28）。
除死亡率和并发症发生率外，未能抢救也应作为医疗质量指标进行监测。术后肾衰竭和败血症的未能抢救率仍然很高，应作为质量改进工作的目标。
