Failure to rescue as a source of variation in hospital mortality after hepatic surgery. BJS 2014; 101: 836-846.

Results

Some 9874 patients were identified. The major complication rate was 19·6 per cent in low‐volume, 19·3 per cent in intermediate‐volume and 16·6 per cent in high‐volume hospitals (P < 0·001). Most common major complications included respiratory insufficiency or failure (8·8 per cent), acute renal failure (4·2 per cent) and gastrointestinal bleeding (3·9 per cent), with each of these complications being less common in high‐volume hospitals (P < 0·050). The incidence of major morbidity following hepatectomy remained the same over the past decade, but failure to rescue patients from these complications decreased (P = 0·011). The overall inpatient mortality rate following liver surgery was 3·2 per cent (3·8, 3·6 and 2·3 per cent for low‐, intermediate‐ and high‐volume hospitals respectively; P < 0·001). The rate of failure to rescue (death after a complication) was higher at low‐ and intermediate‐volume hospitals (16·8 and 16·1 per cent respectively) compared with high‐volume hospitals (11·8 per cent) (P = 0·032). After accounting for patient and hospital characteristics, patients treated at low‐volume hospitals who had a complication were 40 per cent more likely to die than patients with a complication in a high‐volume hospital (odds ratio 1·40, 95 per cent confidence interval 1·02 to 1·93).