Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.ijsu.2022.106890
Title: Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study
Authors: Osorio, Javier
Madrazo, Zoilo
Videla, Sebastian
Sainz, Beatriz
Rodriguez-Gonzalez, Araceli
Campos, Andrea
Santamaria, Maite
Pelegrina, Amalia
Gonzalez-Serrano, Carmen
Aldeano, Aurora
Sarriugarte, Aingeru
Javier Gomez-Diaz, Carlos
Ruiz-Luna, David
Garcia-Ruiz-de-Gordejuela, Amador
Gomez-Gavara, Concepcion
Gil-Barrionuevo, Marta
Vila, Marina
Clavell, Arantxa
Campillo, Beatriz
Millan, Laura
Olona, Carles
Sanchez-Cordero, Sergi
Medrano, Rodrigo
Lopez-Arevalo, Camilo Andres
Perez-Romero, Noelia
Artigau, Eva
Calle, Miguel
Echenagusia, Victor
Otero, Aurema
Tebe, Cristian
Pallares, Natalia
Biondo, Sebastiano
Valderas, Jose Maria 
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Resilience
Failure-to-rescue
Emergency surgery
COVID-19
VENOUS THROMBOEMBOLISM QUALITY
CARE
MORTALITY
POSSUM
Issue Date: 1-Oct-2022
Publisher: ELSEVIER
Citation: Osorio, Javier, Madrazo, Zoilo, Videla, Sebastian, Sainz, Beatriz, Rodriguez-Gonzalez, Araceli, Campos, Andrea, Santamaria, Maite, Pelegrina, Amalia, Gonzalez-Serrano, Carmen, Aldeano, Aurora, Sarriugarte, Aingeru, Javier Gomez-Diaz, Carlos, Ruiz-Luna, David, Garcia-Ruiz-de-Gordejuela, Amador, Gomez-Gavara, Concepcion, Gil-Barrionuevo, Marta, Vila, Marina, Clavell, Arantxa, Campillo, Beatriz, Millan, Laura, Olona, Carles, Sanchez-Cordero, Sergi, Medrano, Rodrigo, Lopez-Arevalo, Camilo Andres, Perez-Romero, Noelia, Artigau, Eva, Calle, Miguel, Echenagusia, Victor, Otero, Aurema, Tebe, Cristian, Pallares, Natalia, Biondo, Sebastiano, Valderas, Jose Maria (2022-10-01). Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study. INTERNATIONAL JOURNAL OF SURGERY 106. ScholarBank@NUS Repository. https://doi.org/10.1016/j.ijsu.2022.106890
Abstract: Background: Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic. Material and methods: Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March–April 2020), non-peak (May–June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay. Results: 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27–3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0–29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01−6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31–4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27–8.00), medium-volume (OR 2.79, 95% CI 1.14–7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07–4.72). Conclusion: FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.
Source Title: INTERNATIONAL JOURNAL OF SURGERY
URI: https://scholarbank.nus.edu.sg/handle/10635/236299
ISSN: 1743-9191
1743-9159
DOI: 10.1016/j.ijsu.2022.106890
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