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 2010-2019 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 2010-2019 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 complications (OR 0.8, 95% CI 0.8-0.9). Differences between centers and over time remained when only analyzing patients undergoing elective surgery.

Conclusion: 

Mortality following colorectal cancer resection has halved over the past decade, predominantly driven by improvements in “rescue” from complications. Differences in FTR also drive hospital-level variation in mortality, highlighting the central importance of “rescue” as a target for surgical quality improvement.

中文翻译：

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结直肠癌切除术后的“抢救失败”：全国术后死亡率研究的变化和改进：降低结直肠手术后的死亡率

客观的： 

旨在检查“抢救失败”(FTR) 的变化作为不同中心之间以及接受结直肠癌手术的患者随时间的死亡率差异的驱动因素。

背景： 

结直肠癌手术后的术后死亡率存在很大差异。FTR 已被认为是术后结果变化的重要决定因素。我们假设不同医院之间和不同时间段内死亡率的差异是由 FTR 的变化引起的。

方法： 

对新西兰 2010 年至 2019 年接受结直肠癌切除术的患者进行了一项全国人群研究。总体计算 90 天 FTR、死亡率和并发症的发生率，以及手术和非手术并发症。根据风险和可靠性调整后的 90 天死亡率，将 20 个地区卫生委员会 (DHB) 划分为四分位数。研究了 10 年来 DHB 之间的变化和趋势。

结果： 

总体而言，纳入了 15,686 名接受结直肠腺癌切除术的患者。高死亡率中心的术后死亡率增加（OR 2.4，95% CI 1.8-3.3）是由于较高的 FTR 率（OR 2.0，95% CI 1.5-2.8）和术后并发症（OR 1.4，95% CI 1.3- 1.6）。这些趋势在手术和非手术并发症中是一致的。2010-2019年期间，术后死亡率减半（OR 0.5，95% CI 0.4-0.6），与并发症（OR 0.8，95% CI 0.8）相比，FTR（OR 0.5，95% CI 0.4-0.7）有更大改善。 -0.9）。当仅分析接受择期手术的患者时，中心之间和时间上的差异仍然存在。

结论： 

过去十年，结直肠癌切除术后的死亡率减少了一半，这主要是由于并发症“抢救”方法的改进。FTR 的差异也导致医院层面死亡率的差异，凸显了“抢救”作为手术质量改进目标的核心重要性。