Cecectomy. Right hemicolectomy*. Left hemicolectomy*. Transverse colectomy. Sigmoidectomy. Multiple segment colectomy*. Partial colectomy*. Laparoscopic ...
Effect of Hospital Teaching Status on Failure-to-Rescue Rates in Abdominal Resection Kyle Barner, BS1 Cameron Hanson, BS1
Catherine Mayer, BS1
Kyle Yuquimpo, BS1
Quoc Tran, BS1
Barth Wright, PhD1
1- Kansas City University of Medicine and Biosciences, College of Osteopathic Medicine, Department of Anatomy
Introduction Failure-to-rescue (FTR) refers to mortality after a major complication and is recognized as an important indicator for patient safety. Prior studies have examined the effect of hospital characteristics on FTR for general classes of surgeries (e.g. pancreatectomy, esophagectomy). In this study, we sought to assess whether teaching hospitals exhibited lower FTR rates relative to other hospitals for patients undergoing specific subgroups of surgical resection procedures (e.g. partial/total pancreatectomy or right/left colectomy).
Methods This retrospective cohort study utilized weighted data from the National Inpatient Sample (NIS) to identify patients (18+ years) who experienced a major complication (e.g. MI, renal failure, see below for complete list) after surgical resection from 2012-2014. ICD-9 procedure/diagnosis codes were used. Patients were categorized according to the type of hospital (teaching vs. non-teaching) in which they were treated. Those missing important clinical identifiers (e.g. age/mortality) were excluded. Inpatient mortality outcomes were examined. Table 1. ICD-9 Codes Used to Identify Complications
Pulmonary failure Pneumonia Myocardial infarction Venous thromboembolism Acute renal failure Post operative bleed Surgical site infection Gastrointestinal bleed
Table 2.
Failure-to-Rescue Rates for Abdominal Resections 0%
5%
10%
15%
20%
25%
30%
35%
Proximal pancreatectomy Distal pancreatectomy* Other partial pancreatectomy Total pancreatectomy Radical pancreaticoduodenectomy
Partial esophagectomy* Total esophagectomy*
Cecectomy Right hemicolectomy* Left hemicolectomy* Transverse colectomy Sigmoidectomy Multiple segment colectomy* Partial colectomy* Laparoscopic total intra-abdominal colectomy* Open total intra-abdominal colectomy*
Teaching Hospitals Non-Teaching Hospitals
Exploratory laparotomy* Reopening of recent laparotomy site* Other laparotomy*
Lobectomy of liver Total hepatectomy* §
518.81,518.4, 518.5, 518.8 481, 482.0-482.9, 483, 484, 485. 507.0 410.00-410.91 415.1, 451.11, 451.19, 451.2, 451.81, 453.8 584 998.1 958.3, 998.3, 998.5, 998.59, 998.51 530.82, 531.00-531.21, 531.40, 531.41, 531.60, 531.61, 532.00532.21, 532.40, 532.41, 532.60, 532.61, 533.00-533.21, 533.40, 533.41, 533.60, 533.61, 534.00534.21, 534.40, 534.41, 534.60, 534.61, 535.01, 535.11, 535.21, 535.31, 535.41, 535.51, 535.61, 578.9
Results ●6 of 9 total resections exhibited higher FTR rates in non-teaching hospitals. ● 11 of 21 partial resections exhibited higher FTR rates in teaching hospitals. ● Total hepatectomy (+53.4%), partial esophagectomy (+14%), partial cholecystectomy (+10.5%) in nonteaching hospitals was significantly higher than in teaching hospitals. ● Multiple segment colectomy (+11.5%), partial gastrectomy w/ anastomosis to esophagus (5.4%), and laparoscopic partial cholecystectomy (4%) in teaching hospitals was significantly higher than in non-teaching hospitals. Acknowledgments: The authors thank John Ashcraft, DO, FACS and Larry Segars, PharmD, DrPH, BCPS, FACE, FCCP, RPh for advice and assistance on this project. © 2017 Kansas City University of Medicine and Biosciences
Partial gastrectomy w/ anast to esophagus* Partial gastrectomy w/ anast to duodenum Partial gastrectomy w/ anast to jejunum* Other partial gastrectomy Laparoscopic vertical (sleeve) gastrectomy Total gastrectomy*
Small bowel resection-multiple segment Small bowel resection-partial* Small bowel resection- total
Partial cholecystectomy* Cholecystectomy Laparoscopic cholecystectomy Laparoscopic partial cholecystectomy*
Laparoscopic lysis of peritoneal adhesions Open lysis of peritoneal adhesions* * indicates p < 0.05 § indicates FTR rate of 75% for Non-Teaching
Conclusion Optimization of post-operative care amongst physicians may decrease the risk of mortality for patients who incur complications after surgical resection. Additionally, our findings suggest that teaching status may play a role in FTR, depending on the specific procedure (see Table 2). Further investigation to elucidate the etiology of increased risk in subsets of resection procedures based on hospital teaching status is warranted.
