The following is the summary of “Interhospital failure to rescue after coronary artery bypass grafting” published in the January 2023 issue of Thoracic and cardiovascular surgery by Likosky, et al.

Researchers investigated whether complications and non-resuscitation account for the observed variance in Coronary artery bypass graft mortality rates between hospitals. Between July 2011 and June 2017, investigators at 90 different hospitals observed 83,747 individuals who had had coronary artery bypass grafting as a stand-alone procedure. They defined rescue failure as the occurrence of surgical mortality in patients experiencing complications. Stroke, surgical reexploration, deep sternal wound infection, renal failure, and prolonged intubation were among the 19 complications. These are the 5 most serious consequences as defined by the Society of Thoracic Surgeons. 

Hospitals were categorized into 3 groups (based on the observed:expected mortality rate) and then compared using 3 different measures of performance: major and overall complication rates, operative mortality, and failure to rescue (among major and overall complications). Hospitals observed and predicted (to address confounding) failure to rescue rates were correlated. The median risk of death as projected by the Society of Thoracic Surgeons was consistent across the observed:expected mortality tertiles of different hospitals (P=.831). Between the lowest and highest quartiles, there was a statistically significant rise in mortality rates (1.4% and 2.8%, respectively). Major complication rates were higher in the lowest tertile (11.1% vs. 12.2%) and total complication rates were higher in the highest tertile (36.6% vs. 35.3%), but these differences were not statistically significant. However, there was a significant increase in the proportion of patients who did not survive the initial attempt at rescue from the lowest to the highest tertile, both in terms of the severity of their difficulties and the number of complications they experienced overall. 

Patients with major (R² =0.14) and overall (R²= 0.51) problems showed a positive correlation between the observed and expected failure to rescue rates at the hospital. The need of establishing best practices at high-performing institutions, such as early diagnosis and management of problems, is underscored by the documented interhospital variability in successful rescue following coronary artery bypass grafting.

Source: sciencedirect.com/science/article/abs/pii/S002252232100163X