Failure to rescue in XXXX : Coming to terms with the second term.

@entity1 @entity1984 @entity16 @entity204 @entity130
INTRODUCTION: The failure to rescue (FTR) rate is the probability of @entity204 after a major complication and was defined in elective surgical cohorts. In elective surgery, the precedence rate (proportion of @entity204 preceded by major complications) approaches 100%, but recent studies in @entity130 report rates of only 20-25%. We hypothesised that use of high quality data would result precedence rates in higher than those derived from national datasets, and we further sought to characterise the nature of those @entity204 not preceded by major complications. METHODS: Prospectively collected data from 2006 to 2010 from a single level I @entity130 centre were used. @entity1 age >16 years with @entity1984 >= 2 who survived beyond the @entity130 bay were included. Complications, mortality, FTR, and precedence rates were calculated. Chart abstraction was performed for registry @entity204 without recorded complications to verify the absence of complications and determine the cause of @entity204 , after which outcomes were re-calculated. RESULTS: A total of 8004 @entity1 were included (median age 41 (IQR 25-75), 71% male, 82% blunt, median ISS 10 (IQR 5-18)). Using registry data the precedence rate was 55%, with 132/293 (45%) @entity204 occurring without antecedent major complications. On chart abstraction, 11/132 (8%) @entity1 recorded in the registry as having no complication prior to @entity204 were found to have major complications. Complication and FTR rates after chart abstraction were statistically significantly different than those derived from registry data alone (complications 16.5% vs. 16.3, FTR 12.3 vs.13, p=0.001), but this difference was unlikely to be clinically meaningful. @entity1 dying without complications predominantly (87%) had neurologic causes of demise. CONCLUSIONS: Use of data with near-complete ascertainment of complications results in precedence rates much higher than those from national datasets. @entity1 dying without precedent complications at our centre largely succumbed to progression of @entity16 . Attempts to use FTR to compare quality between centres should be limited to high quality data. LEVEL OF EVIDENCE: Level III. RETROSPECTIVE COHORT STUDY: Outcomes.
