Edwards Fred H, Ferraris Victor A, Kurlansky Paul A, Lobdell Kevin W, He Xia, O'Brien Sean M, Furnary Anthony P, Rankin J Scott, Vassileva Christina M, Fazzalari Frank L, Magee Mitchell J, Badhwar Vinay, Xian Ying, Jacobs Jeffrey P, Wyler von Ballmoos Moritz C, Shahian David M
Department of Surgery, University of Florida, Jacksonville, Florida.
Department of Surgery, University of Kentucky, Lexington, Kentucky.
Ann Thorac Surg. 2016 Aug;102(2):458-64. doi: 10.1016/j.athoracsur.2016.04.051. Epub 2016 Jun 22.
Failure to rescue (FTR) is increasingly recognized as an important quality indicator in surgery. The Society of Thoracic Surgeons National Database was used to develop FTR metrics and a predictive FTR model for coronary artery bypass grafting (CABG).
The study included 604,154 patients undergoing isolated CABG at 1,105 centers from January 2010 to January 2014. FTR was defined as death after four complications: stroke, renal failure, reoperation, and prolonged ventilation. FTR was determined for each complication and a composite of the four complications. A statistical model to predict FTR was developed.
FTR rates were 22.3% for renal failure, 16.4% for stroke, 12.4% for reoperation, 12.1% for prolonged ventilation, and 10.5% for the composite. Mortality increased with multiple complications and with specific combinations of complications. The multivariate risk model for prediction of FTR demonstrated a C index of 0.792 and was well calibrated, with a 1.0% average difference between observed/expected (O/E) FTR rates. With centers grouped into mortality terciles, complication rates increased modestly (11.4% to 15.7%), but FTR rates more than doubled (6.8% to 13.9%) from the lowest to highest terciles. Centers in the lowest complication rate tercile had an FTR O/E of 1.14, whereas centers in the highest complication rate tercile had an FTR O/E of 0.91.
CABG mortality rates vary directly with FTR, but complication rates have little relation to death. FTR rates derived from The Society of Thoracic Surgeons data can serve as national benchmarks. Predicted FTR rates may facilitate patient counseling, and FTR O/E ratios have promise as valuable quality metrics.
未能成功挽救（FTR）日益被视为外科手术中的一项重要质量指标。胸外科医师协会国家数据库被用于制定FTR指标以及冠状动脉旁路移植术（CABG）的FTR预测模型。
该研究纳入了2010年1月至2014年1月期间在1105个中心接受单纯CABG的604154例患者。FTR被定义为在出现四种并发症（中风、肾衰竭、再次手术和通气延长）后死亡。针对每种并发症以及这四种并发症的组合确定FTR。开发了一个预测FTR的统计模型。
肾衰竭的FTR率为22.3%，中风为16.4%，再次手术为12.4%，通气延长为12.1%，四种并发症组合的FTR率为10.5%。死亡率随着多种并发症以及特定并发症组合而增加。预测FTR的多变量风险模型的C指数为0.792，校准良好，观察到的/预期的（O/E）FTR率之间的平均差异为1.0%。将中心按死亡率三分位数分组后，并发症发生率适度增加（从11.4%至15.7%），但FTR率从最低三分位数到最高三分位数增加了一倍多（从6.8%至13.9%）。并发症发生率最低三分位数的中心FTR的O/E为1.14，而并发症发生率最高三分位数的中心FTR的O/E为0.91。
CABG死亡率与FTR直接相关，但并发症发生率与死亡关系不大。从胸外科医师协会数据得出的FTR率可作为全国基准。预测的FTR率可能有助于患者咨询，且FTR的O/E比率有望成为有价值的质量指标。
