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. 2013 Nov;209(5):420.e1-8.
doi: 10.1016/j.ajog.2013.08.006. Epub 2013 Aug 9.

Failure to rescue after major gynecologic surgery

Jason D Wright  1 , Cande V Ananth, Laureen Ojalvo, Thomas J Herzog, Sharyn N Lewin, Yu-Shiang Lu, Alfred I Neugut, Dawn L Hershman
Affiliations

Failure to rescue after major gynecologic surgery

Jason D Wright et al. Am J Obstet Gynecol. 2013 Nov.

Abstract

Objective: There is growing recognition that, in addition to occurrence of perioperative complications, the treatment of patients with complications influences outcome. We examined complications, failure to rescue (death in patients with a complication), and mortality rates for women who underwent abdominal hysterectomy.

Study design: Women who underwent abdominal hysterectomy from 1998-2010 and whose data were recorded in the Nationwide Inpatient Sample were identified. Hospitals were stratified based on risk-adjusted mortality rates into 5 quintiles, and rates of complications and failure to rescue were examined.

Results: A total of 664,229 women who had been treated at 741 hospitals were identified. The overall mortality rate for the cohort was 0.17%. The risk-adjusted, hospital-level mortality rate ranged from 0-1.12%. The complication rate was 6.5% at the hospitals with the lowest mortality rates, 9.9% at the second quintile hospitals, 9.5% at both the third and fourth quintile hospitals, and 7.9% at the hospitals with the highest mortality rates. In contrast to complications, the failure-to-rescue rate increased with each successive risk-adjusted mortality quintile. The failure-to-rescue rate was 0% at the hospitals with the lowest mortality rates and increased with each successive quintile to 1.1%, 2.1%, 2.7%, and 4.4% in the hospitals with the highest mortality rates (P < .0001).

Conclusion: For women who underwent abdominal hysterectomy, hospital complication rates correlated poorly with mortality rates; failure-to-rescue is strongly associated with in-hospital mortality rates. The treatment of complications, not the actual development of a complication, is the most important factor to use to predict death after major gynecologic surgery.

Keywords: complications; failure to rescue; gynecology; hysterectomy; mortality rate.

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Conflict of interest statement

The authors report no conflict of interest.

Figures

Figure 1
Figure 1. Complication and failure to rescue rates stratified by year of diagnosis
Figure 2
Figure 2. Complications and failure to rescue stratified by hospital risk-adjusted mortality quintiles
All complications, medical complications, and infectious complications are presented.
See this image and copyright information in PMC

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