Department of Surgery, Orebro University Hospital, Orebro, Sweden.
Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden; School of Medical Sciences, Orebro University, Sweden; Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Surgery. 2021 Sep;170(3):863-869. doi: 10.1016/j.surg.2021.01.050. Epub 2021 Mar 9.
Failure-to-rescue is a quality indicator measuring the response to postoperative complications. The current study aims to compare failure-to-rescue in patients suffering severe complications after surgery for colorectal cancer between hospitals based on their university status.
Patients undergoing colorectal cancer surgery from January 2015 to January 2020 in Sweden were included through the Swedish Colorectal Cancer Registry in the current study. Severe postoperative complications were defined as Clavien-Dindo ≥3. Failure-to-rescue incidence rate ratios were calculated comparing university versus nonuniversity hospitals.
A total of 23,351 patients were included in this study, of whom 2,964 suffered severe postoperative complication(s). University hospitals had lower failure-to-rescue rates with an incidence rate ratios of 0.62 (0.46-0.84, P = .002) compared with nonuniversity hospitals. There were significantly lower failure-to-rescue rates in almost all types of severe postoperative complications at university than nonuniversity hospitals.
University hospitals have a lower risk for failure-to-rescue compared with nonuniversity hospitals. The exact mechanisms behind this finding are unknown and warrant further investigation to identify possible improvements that can be applied to all hospitals.
失败救援是衡量术后并发症应对能力的质量指标。本研究旨在比较基于大学地位的医院中，接受结直肠癌手术后发生严重并发症的患者的失败救援情况。
本研究通过瑞典结直肠癌登记处纳入了 2015 年 1 月至 2020 年 1 月期间在瑞典接受结直肠癌手术的患者。严重术后并发症定义为 Clavien-Dindo ≥3。计算大学医院与非大学医院之间失败救援发生率的比值比。
本研究共纳入 23351 例患者，其中 2964 例发生严重术后并发症。与非大学医院相比，大学医院的失败救援率较低，发生率比值比为 0.62（0.46-0.84，P=0.002）。在大学医院，几乎所有类型的严重术后并发症的失败救援率均明显较低。
与非大学医院相比，大学医院的失败救援风险较低。这一发现背后的确切机制尚不清楚，需要进一步研究以确定可能适用于所有医院的改进措施。
