FAILURE TO RESCUE CONTRIBUTES TO CENTER-LEVEL DIFFERENCES IN MORTALITY AFTER LUNG TRANSPLANTATION.
BACKGROUND: The clinical response to postoperative complications after lung transplantation (LTx) may contribute to mortality differences between transplant centers. The ability to avoid mortality following a complication - Failure to Rescue (FTR) - may be an effective quality metric in lung transplantation. METHODS: The United Network for Organ Sharing (UNOS) database was queried for adult, first-time, lung-only transplantations from 05/2005 to 12/2015. Transplantation centers were stratified into equal-sized terciles based on observed operative mortality rates. Several post-operative complications were identified including stroke, acute rejection, acute-kidney-injury requiring hemodialysis, airway dehiscence and extra-corporeal-membrane-oxygenation 72-hours after surgery. Rates of FTR were calculated as the number of operative mortalities in patient who suffered complications divided by the number of patients who suffered any postoperative complications. RESULTS: Our study population included 16,411 LTx performed at 69 transplant centers. LTx centers were stratified into terciles with average peri-operative mortality of 4.0% for low-mortality centers, 6.9% for intermediate-mortality centers and 12.4% for high-mortality centers. Low-mortality centers had slightly lower complication rates (Low-15.0% vs. Intermediate-17.1% vs. High-19.1%, P<0.001). Differences in FTR rate were significantly more pronounced (Low-14.9% vs. Intermediate-23.9% vs. High-34.2%, P<0.001). Multivariable logistic regression and generalized linear models demonstrated an independent association between high FTR rates and high mortality in LTx (p<0.001). CONCLUSIONS: Differences in rates of Failure to Rescue contribute significantly to per-center variability in mortality following LTx. FTR can serve as a quality metric to identify opportunities for improvement in management of perioperative adverse events.
Osho, AA; Bishawi, MM; Mulvihill, MS; Axtell, AL; Hirji, SA; Spencer, PJ; Heng, EE; D'Alessandro, DA; Melnitchouk, S; Hartwig, MG; Villavicencio, MA
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