Abstract
Despite the wide acceptance of Failure-to-Rescue (FTR) as a patient safety indicator (defined as the deaths among surgical patients with treatable complications), no study has explored the geographic variation of FTR in a large health jurisdiction. Our study aimed to explore the spatiotemporal variations of FTR rates across New South Wales (NSW), Australia. We conducted a population-based study using all admitted surgical patients in public acute hospitals during 2002–2009 in NSW, Australia. We developed a spatiotemporal Poisson model using Integrated Nested Laplace Approximation (INLA) methods in a Bayesian framework to obtain area-specific adjusted relative risk. Local Government Area (LGA) was chosen as the areal unit. LGA-aggregated covariates included age, gender, socio-economic and remoteness index scores, distance between patient residential postcode and the treating hospital, and a quadratic time trend. We studied 4,285,494 elective surgical admissions in 82 acute public hospitals over eight years in NSW. Around 14% of patients who developed at least one of the six FTR-related complications (58,590) died during hospitalization. Of 153 LGAs, patients who lived in 31 LGAs, accommodating 48% of NSW patients at risk, were exposed to an excessive adjusted FTR risk (10% to 50%) compared to the state-average. They were mostly located in state's centre and western Sydney. Thirty LGAs with a lower adjusted FTR risk (10% to 30%), accommodating 8% of patients at risk, were mostly found in the southern parts of NSW and Sydney east and south. There were significant spatiotemporal variations of FTR rates across NSW over an eight-year span. Areas identified with significantly high and low FTR risks provide potential opportunities for policy-makers, clinicians and researchers to learn from the success or failure of adopting the best care for surgical patients and build a self-learning organisation and health system.
Highlights
Adverse events during hospitalisation and complications after surgery can be quite common
We aimed to investigate the spatiotemporal pattern of post-surgery FTR rate for all public acute hospital patients in New South Wales (NSW), Australia during 2002–2009, in order to enhance our understanding of geographical variation of FTR across NSW
Patients who resided in metropolitan areas had lower crude FTR rates compared to those patients residing in non-metropolitan areas
Summary
Adverse events during hospitalisation and complications after surgery can be quite common. In the U.S, approximately onefifth of patients who underwent surgery in 1997 died due to treatable complications [1]. In Australia, between 15 to 20% of patients experienced at least one complication after the surgery; 5% to 7% of them died prior to discharge [2,3,4]. Recognition and effective treatment of the complication once it occurs can prevent patient death [5]. Silber and colleagues [6] proposed to measure Failure-to-Rescue (FTR), defined as the proportion of deaths among surgical in-patients with treatable complications, as a hospital quality indicator. Effective management of treatable post-operative complications reportedly made a larger contribution to patient survival than pre-operation patient characteristics or operation type [7]. Two studies reported a decreased FTR rate of 2.4% to 6% within one decade [16,17]
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