Failure to rescue among octogenarians undergoing cardiac surgery in the United States.

Aug 07, 2023

Experts: Sara Sakowitz,Syed Shahyan Bakhtiyar,Amulya Vadlakonda,Konmal Ali,Yas Sanaiha,Peyman Benharash

A rapidly growing population, octogenarians are considered at high-risk for mortality and complications after cardiac surgery. Given the recent addition of failure to rescue as a Society of Thoracic Surgeons quality metric, a better understanding of patient and operative factors predictive of failure to rescue in this cohort is warranted.
The 2010-2020 Nationwide Readmissions Database was used to identify all patients ≥80 years undergoing first-time, elective coronary artery bypass grafting or concomitant valve operations. Patients experiencing failure to rescue, defined as mortality after a major or minor complication, were classified as Failure to Rescue (others: Non-Failure to Rescue). Multivariable regression models were developed to ascertain significant perioperative factors associated with failure to rescue.
Of ∼562,794 octogenarian patients, 76,473 (13.6%) developed complications. Of these, 7,055 (9.2%) experienced failure to rescue. The incidence of failure to rescue decreased across the study time course (9.7% in 2010 to 7.6% in 2019, P = .001). After risk adjustment, age (adjusted odds ratio, 1.05/year; 95% confidence interval, 1.03-1.07), female sex (adjusted odds ratio, 1.40; 95% confidence interval, 1.27-1.53), congestive heart failure (adjusted odds ratio, 1.54; 95% confidence interval, 1.38-1.71), late-stage kidney disease (adjusted odds ratio, 2.38; 95% confidence interval, 1.79-3.17), liver disease (adjusted odds ratio, 9.59; 95% confidence interval, 8.17-11.26), and cerebrovascular disease (adjusted odds ratio, 2.42; 95% confidence interval, 2.12-2.76) were associated with failure to rescue. Relative to isolated coronary artery bypass grafting, combined coronary artery bypass grafting-valve (adjusted odds ratio, 1.67; 95% confidence interval, 1.43-1.95) and multi-valve procedures (adjusted odds ratio, 2.23; 95% confidence interval, 1.75-2.85) were linked with greater odds of failure to rescue. There was no association between failure to rescue and hospital volume.
Despite improvements in perioperative management, failure to rescue occurs in ∼9% of octogenarians undergoing elective cardiac operations. Although incidence has declined over the past decade, the continued prevalence of failure to rescue underscores the need for novel risk assessments and targeted interventions.

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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ABOUT THE EXPERTS

Sara Sakowitz,Syed Shahyan Bakhtiyar,Amulya Vadlakonda,Konmal Ali,Yas Sanaiha,Peyman Benharash

Sara Sakowitz

Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA. Electronic address: https://twitter.com/sarasakowitz.

Syed Shahyan Bakhtiyar

Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of Colorado, Aurora, CO.

Amulya Vadlakonda

Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA.

Konmal Ali

Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA.

Yas Sanaiha

Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA.

Peyman Benharash

Cardiovascular Outcomes Research Laboratories, University of California, Los Angeles, CA; Department of Surgery, University of California, Los Angeles, CA. Electronic address: PBenharash@mednet.ucla.edu.