Service of Thoracic Surgery, Salamanca University Hospital, Salamanca, Spain.
Salamanca Institute of Biomedical Research (IBSAL), Spain.
Arch Bronconeumol (Engl Ed). 2021 Apr;57(4):251-255. doi: 10.1016/j.arbres.2019.12.009. Epub 2020 Jan 22.
Failure to rescue (FTR) is defined by the number of deaths among patients experiencing major complications after surgery. In this report we analyze FTR and apply a cumulative sum control chart (CUSUM) methodology for monitoring performance in a large series of operated lung carcinoma patients.
Prospectively stored records of cases undergoing anatomical lung resection in one center were reviewed. Postoperative adverse events were coded and included as a binary variable (major, or minor complications). The occurrence of 30-day mortality was also recorded. Patients dying after suffering major complications were considered as FTR. Risk-adjusted CUSUM graphs using EuroLung1 and 2 variables were constructed for major complications and FTR. Points of plateauing or trend inversion were checked to detect intentional or non-adverted changes in the process of care.
2237 cases included. 9.1% cases suffered major complications. The number of cases considered as failures to rescuing was 46 (2.1% of the total series and 22.5% of cases having major complications). The predictive performance of EuroLung1 and 2 models was as follows: EuroLung1 (major morbidity) C-index 0.70 (95%CI: 0.66-0.73); EuroLung2 (applied to FTR) C-index 0.81 (95%CI: 0.750.87). CUSUM graphs depicted improvement in rescuing complicated patients after case 330 but no improvement in the rate of non-complicated cases until case 720.
FTR offers a complementary view to classical outcomes for quality assessment in Thoracic Surgery. Our study also shows how the analysis of FTR on time series can be applied to evaluate changes in team performance along time.
失救（FTR）的定义是手术后出现重大并发症的患者的死亡人数。在本报告中，我们分析了 FTR，并应用累积和控制图（CUSUM）方法监测了一系列大型肺癌手术患者的表现。
回顾了一个中心进行解剖性肺切除术的病例的前瞻性存储记录。将术后不良事件编码为二进制变量（主要或次要并发症）。还记录了 30 天死亡率。发生重大并发症后死亡的患者被认为是 FTR。使用 EuroLung1 和 2 变量构建了用于主要并发症和 FTR 的风险调整 CUSUM 图。检查平台期或趋势反转点，以检测护理过程中的有意或非故意变化。
纳入 2237 例患者。9.1%的患者发生主要并发症。考虑失救的病例数为 46 例（占总系列的 2.1%，占发生重大并发症病例的 22.5%）。EuroLung1 和 2 模型的预测性能如下：EuroLung1（主要发病率）C 指数为 0.70（95%CI：0.66-0.73）；EuroLung2（用于 FTR）C 指数为 0.81（95%CI：0.750.87）。CUSUM 图显示，在第 330 例患者后，抢救复杂患者的能力有所提高，但在第 720 例患者之前，非复杂患者的抢救率没有提高。
FTR 为胸外科质量评估提供了一种补充的结果视角。我们的研究还展示了如何在时间序列上分析 FTR，以评估团队表现随时间的变化。
