Implementation of Critical Care Response Teams in Ontario: Impact on the Outcomes of Surgical Patients

Ann Surg. 2020 Nov 17. doi: 10.1097/SLA.0000000000004629. Online ahead of print.

Abstract

Objective: To evaluate whether introduction of Critical Care Response Teams (CCRTs) reduced mortality rates among patients who developed a post-operative complication, also referred to as failure to rescue (FTR).

Background: CCRTs were introduced to improve patients' post-operative outcomes. Its effect on FTR continues to be actively investigated.

Methods: We conducted a population-based retrospective cohort study using administrative data from Ontario, Canada. We identified 810,279 patients admitted to hospital for major surgical procedures between January 2004 and December 2014, with a washout period consisting of the 9 months before and after the implementation of CCRTs in January 2007. Difference-in-differences analysis among patients who developed a post-operative complication (n=148,882) was used to estimate the association between CCRT implementation and FTR before and after CCRT implementation in hospitals that did- vs. did not- implement CCRT during the study period.

Results: A total of 810,279 patients were included, of whom 148,882 (18.4%) developed a post-operative surgical complication. Among patients who developed a post-operative complication, the overall proportion of FTR was 9.2% (n=13,659). Among patients in hospitals that introduced CCRT, the relative risk (RR) of FTR was 0.84, (95% confidence interval (CI) 0.78-0.90) after implementation of CCRT, while over the same time period, the RR was 0.85 (95% CI 0.80-0.91) in hospitals that did not implement CCRT. The relative risk ratio (difference-in-differences) was 0.99 (95% CI 0.89-1.09). Among patients undergoing orthopedic surgery, the relative risk ratio was 0.84 (95% CI 0.75-0.95).

Conclusion: While implementation of CCRTs in hospitals in Ontario, Canada, did not reduce FTR among all surgical patients having surgery, CCRTs may reduce the risk of FTR among patients having orthopedic surgery.