Higher Failure-to-Rescue Rates in Lung Cancer Resections Reported at Hospitals With High Mortality Rates in Major Cancer Resections
In a retrospective cohort study reported in JAMA Surgery, Grenda et al found higher mortality and higher failure to rescue rates in patients undergoing lung resection at hospitals with high vs low mortality rates in major cancer resections.
Study Details
In the study, hospitals with the lowest and highest mortality rates were identified from among 1,279 hospitals participating in the National Cancer Data Base from January 2005 to December 2006 using a composite measure derived from procedural volumes and mortality rates of major cancer resections. Outcomes data were collected between January 2006 and December 2007 on 645 lung resections performed in 18 low-mortality hospitals (n = 441) and 25 high-mortality hospitals (n = 204). Analysis was adjusted for patient characteristics, and hierarchical logistic regression was used to assess differences in the incidence of complications and “failure to rescue,” defined as death following a complication.
Mortality and Complication Rates
Patients undergoing resection at high-mortality hospitals had greater illness severity, including greater proportions of patients with poorer functional status and more than two comorbid conditions, including ischemic heart disease and diabetes. High-mortality hospitals also performed a significantly higher percentage of emergency procedures. Unadjusted mortality rates were 1.6% at low-mortality hospitals and 10.8% at high-mortality hospitals (P < .001), with the difference remaining significant after risk adjustment (1.8% vs 8.1%, P < .001).
Complication rates were nonsignificantly higher in high-mortality hospitals (23.3% vs 15.6%, adjusted odds ratio [aOR] = 1.79, 95% confidence interval [CI] = 0.99–3.21), with surgical complications (aOR = 0.73, 95% CI = 0.26–2.00) and cardiopulmonary complications being similar (aOR = 1.23, 95% CI = 0.70–2.16). Failure-to-rescue rates were significantly higher in high-mortality hospitals (25.9% vs 8.7%, aOR = 6.55, 95% CI = 1.44–29.88).
The investigators concluded, “Failure-to-rescue rates are higher at high-mortality hospitals, which may explain the large differences between hospitals in mortality rates following lung cancer resection. This finding emphasizes the need for better understanding of the factors related to complications and their subsequent management.”
Tyler R. Grenda, MD, of the Center for Healthcare Outcomes and Policy, University of Michigan, is the corresponding author of the JAMA Surgery article.
The study was supported by the Agency for Healthcare Research and Quality and National Cancer Institute.
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