“Failure to Rescue” following Colorectal Cancer Resection: Variation and Improvements in a National Study of Postoperative Mortality
Abstract
Objective To examine variation in "failure to rescue" (FTR) as a driver of differences in mortality between centres and over time for patients undergoing colorectal cancer surgery. Background Wide variation exists in postoperative mortality following colorectal cancer surgery. FTR has been identified as an important determinant of variation in postoperative outcomes. We hypothesized that differences in mortality both between hospitals and over time are driven by variation in FTR. Methods A national population-based study of patients undergoing colorectal cancer resection from 2010 to 2019 in Aotearoa New Zealand was conducted. Rates of 90-day FTR, mortality, and complications were calculated overall, and for surgical and nonoperative complications. Twenty District Health Boards (DHBs) were ranked into quartiles using risk- and reliability-adjusted 90-day mortality rates. Variation between DHBs and trends over the 10-year period were examined. Results Overall, 15,686 patients undergoing resection for colorectal adenocarcinoma were included. Increased postoperative mortality at high-mortality centers (OR 2.4, 95% CI 1.8-3.3) was driven by higher rates of FTR (OR 2.0, 95% CI 1.5-2.8), and postoperative complications (OR 1.4, 95% CI 1.3-1.6). These trends were consistent across operative and nonoperative complications. Over the 2010 to 2019 period, postoperative mortality halved (OR 0.5, 95% CI 0.4-0.6), associated with a greater improvement in FTR (OR 0.5, 95% CI 0.4-0.7) than c…
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Situational awareness and anticipatory guidance support early recognition and coordinated treatment of complications, which substantially reduce postoperative mortality and morbidity.
“These 2 functions support early recognition and coordinated treatment of complications, which have substantial effects reducing postoperative mortality and morbidity. 14”
From Potential uses of AI for perioperative nursing handoffs: a qualitative study (2023) · cites this paper as [14]
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- Authors
- Wells, C. I., Varghese, C., Boyle, L. J., McGuinness, M. J., Keane, C., O’Grady, G., Gurney, J., Koea, J., Harmston, C., & Bissett, I. P.
- Affiliations
- University of Auckland (NZ)
- Northland District Health Board (NZ)
- University of Otago (NZ)
- Waitemata District Health Board (NZ)
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Corresponding author
- Wells, Cameron I.
- Varghese, Chris
- Keane, Celia
- O’Grady, Greg
- Bissett, Ian P.
- ORCID
- Venue
- Annals of Surgery
- Published
- 2022-08-03
- Volume
- 278
- Issue
- 1
- Pages
- 87-95
- ISSN
- 0003-4932 (ISSN-L)
- OpenAlex
- W4289786350
- Cited by
- 28
- References
- 55
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 9 · 2023: 5
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
- Keywords
- failure to rescue, colorectal cancer surgery, postoperative mortality, postoperative complications, hospital-level variation, surgical quality improvement, colorectal adenocarcinoma, New Zealand
- MeSH terms
- Hexestrol, Humans, Postoperative Complications, Retrospective Studies, Colorectal Neoplasms, Reproducibility of Results, Hospital Mortality
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