Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009

Lixin Ou; Jack Chen; Hassan Assareh; Stephanie J Hollis; Ken Hillman; Arthas Flabouris

doi:10.1371/journal.pone.0096164

Trends and variations in the rates of hospital complications, failure-to-rescue and 30-day mortality in surgical patients in New South Wales, Australia, 2002-2009

PLoS One. 2014 May 1;9(5):e96164. doi: 10.1371/journal.pone.0096164. eCollection 2014.

Authors

Lixin Ou¹, Jack Chen¹, Hassan Assareh¹, Stephanie J Hollis¹, Ken Hillman¹, Arthas Flabouris²

Affiliations

¹ Simpson Centre for Health Services Research, South Western Sydney Clinical School & Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia.
² Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia, Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia.

Abstract

Background: Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator.

Methods: We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics.

Results: The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group.

Conclusions: The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the potential for further quality improvement intervention opportunities.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Female
Hospital Mortality / trends*
Humans
Male
Middle Aged
New South Wales / epidemiology
Patient Safety
Poisson Distribution
Postoperative Complications / etiology
Postoperative Complications / mortality*
Risk Factors
Young Adult

Grants and funding

The study was funded by grant (APP1009916 & APP1020660) from Australian Government National Health and Medical Research Council. web: www.nhmrc.gov.au. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.