Use of failure-to-rescue after emergency surgery as a dynamic indicator of hospital resilience during the COVID-19 pandemic. A multicenter retrospective propensity score-matched cohort study.

Autor: Osorio J; Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain. Electronic address: josorio@bellvitgehospital.cat., Madrazo Z; Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain., Videla S; Department of Clinical Pharmacology, Clinical Research Support Unit (HUB-IDIBELL), Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain., Sainz B; Department of Surgery, Complejo Hospitalario de Navarra, Pamplona, Spain., Rodríguez-Gonzalez A; Department of Surgery, Donostia University Hospital, San Sebastian, Spain., Campos A; Department of Surgery, Parc Taulí Health Corporation, Sabadell Hospital, Sabadell, Spain., Santamaria M; Department of Surgery, Arnau de Vilanova University Hospital, Lleida, Spain., Pelegrina A; Department of Surgery, Hospital Del Mar University Hospital, Barcelona, Spain., Gonzalez-Serrano C; Department of Surgery. Basurto University Hospital, Bilbao, Spain., Aldeano A; Department of Surgery, Granollers General Hospital, Granollers, Spain., Sarriugarte A; Department of Surgery, Cruces University Hospital, Bilbao, Spain., Gómez-Díaz CJ; Department of Surgery, Althaia Foundation, University Healthcare Network, Manresa, Spain., Ruiz-Luna D; Department of Surgery, Terrassa Health Consortium, Terrassa Hospital, Terrassa, Spain., García-Ruiz-de-Gordejuela A; General Surgery Department, Vall D'Hebrón University Hospital, Barcelona, Spain., Gomez-Gavara C; Hepatobiliopancreatic Surgery and Transplantation Department, Vall D'Hebrón University Hospital, Barcelona, Spain., Gil-Barrionuevo M; Department of Surgery, Viladecans Hospital, Viladecans, Spain., Vila M; Department of Surgery, Mataró Hospital, Maresme Health Consortium, Mataró, Spain., Clavell A; Department of Surgery, Germans Trias I Pujol University Hospital, Badalona, Spain., Campillo B; Department of Surgery, Sant Joan de Deu Hospital Foundation, Martorell, Spain., Millan L; Department of Surgery, Dr. José Molina Orosa Hospital, Lanzarote, Spain., Olona C; Department of Surgery, Joan XXIII University Hospital, Tarragona, Spain., Sanchez-Cordero S; Department of Surgery, Igualada University Hospital, Anoia Health Consortium, Igualada, Spain., Medrano R; Department of Surgery, Sant Pau University Hospital, Barcelona, Spain., Lopez-Arevalo CA; Department of Surgery. Moisés Broggi Hospital, Sant Joan Despí, Spain., Pérez-Romero N; Department of Surgery, Mútua de Terrassa University Hospital, Terrassa, Spain., Artigau E; Department of Surgery, Dr. Josep Trueta University Hospital, Girona, Spain., Calle M; Department of Surgery, Alto Deba Hospital, Mondragon, San Sebastian, Spain., Echenagusia V; Department of Surgery, Araba University Hospital, Txagorritxu Hospital, Vitoria, Spain., Otero A; Clinical Research Support Unit, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet Del Llobregat, Barcelona, Spain., Tebe C; Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain., Pallares N; Biostatistics Unit of the Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain., Biondo S; Department of Surgery, Hospital Universitari de Bellvitge, L'Hospitalet Del Llobregat, Barcelona, Spain., Valderas JM; Department of Family Medicine, Yong Loo Lin School of Medicine, National University Health System, Singapore.
Jazyk: angličtina
Zdroj: International journal of surgery (London, England) [Int J Surg] 2022 Oct; Vol. 106, pp. 106890. Date of Electronic Publication: 2022 Sep 09.
DOI: 10.1016/j.ijsu.2022.106890
Abstrakt: Background: Surgical failure-to-rescue (FTR, death rate following complications) is a reliable cross-sectional quality of care marker, but has not been evaluated dynamically. We aimed to study changes in FTR following emergency surgery during the COVID-19 pandemic.
Material and Methods: Matched cohort study including all COVID-19-non-infected adult patients undergoing emergency general surgery in 25 Spanish hospitals during COVID-19 pandemic peak (March-April 2020), non-peak (May-June 2020), and 2019 control periods. A propensity score-matched comparative analysis was conducted using a logistic regression model, in which period was regressed on observed baseline characteristics. Subsequently, a mixed effects logistic regression model was constructed for each variable of interest. Main variable was FTR. Secondary variables were post-operative complications, readmissions, reinterventions, and length of stay.
Results: 5003 patients were included (948, 1108, and 2947 in the pandemic peak, non-peak, and control periods), with comparable clinical characteristics, prognostic scores, complications, reintervention, rehospitalization rates, and length of stay across periods. FTR was greater during the pandemic peak than during non-peak and pre-pandemic periods (22.5% vs. 17.2% and 12.7%), being this difference confirmed in adjusted analysis (odds ratio [OR] 2.13, 95% confidence interval [95% CI] 1.27-3.66). There was sensible inter-hospital variability in FTR changes during the pandemic peak (median FTR change +8.77%, IQR 0-29.17%) not observed during the pandemic non-peak period (median FTR change 0%, IQR -6.01-6.72%). Greater FTR increase was associated with higher COVID-19 incidence (OR 2.31, 95% CI 1.31-4.16) and some hospital characteristics, including tertiary level (OR 3.07, 95% CI 1.27-8.00), medium-volume (OR 2.79, 95% CI 1.14-7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07-4.72).
Conclusion: FTR following emergency surgery experienced a heterogeneous increase during different periods of the COVID-19 pandemic, suggesting it to behave as an indicator of hospital resilience. FTR monitoring could facilitate identification of centres in special needs during ongoing health care challenges.
Competing Interests: Declaration of competing interest The authors have no competing interests to declare.
(Copyright © 2022 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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