G. Barmparas1, J. Murry1, M. Martin2, D. A. Wiegmann3, K. R. Catchpole1, B. L. Gewertz1, E. Ley1 1Cedars-Sinai Medical Center,Division Of Acute Care Surgery And Surgical Critical Care / Department Of Surgery,Los Angeles, CA, USA 2Madigan Army Medical Center,Department Of Surgery,Tacoma, WA, USA 3University Of Wisconsin,Madison College Of Engineering,Madison, WI, USA
Introduction: Failure to rescue (FTR), defined as any death following the development of in-hospital complications, has become an important quality measure. The purpose of this investigation was to examine whether older patients are at higher risk of FTR following traumatic injuries.
Methods: National Trauma Databank (NTDB) datasets 2007-2011 were queried. Patients ≥ 16 years admitted to centers reporting ≥ 80% of AIS and/or ≥ 20% of comorbidities, with ≥ 200 subjects in the NTDB and who had any reported complication were reviewed. Those who survived (non-FTR) were compared to those who did not (FTR) using a forward logistic regression model.
Results: Of 3,313,117 eligible patients, 218,986 (6.6%) met inclusion criteria and had at least one complication reported. Of these, 201,358 (91.2%) survived their complication (non-FTR) and 17,628 (8.8%) died (FTR). A forward logistic regression identified 22 variables as predictors of FTR. Of those, age 65 to 89 years was the strongest predictor (AOR [95% CI]: 6.58 [6.11, 7.08], p<0.001), followed by the need for mechanical ventilation (AOR [95% CI]: 2.99 [2.81, 3.17], p<0.001) and ICU admission (AOR [95% CI]: 2.61 [2.40, 2.84], p<0.001). Using age group 16 to 45 years as the reference group, the adjusted risk for FTR increased with increasing age in a stepwise fashion [AOR [95% CI]: 1.94 [1.80, 2.09] for age 46 to 65 years, 6.78 [6.19, 7.42] for age 66 to 89 years and 27.58 [21.81, 34.87] for age ≥ 90 years]. The adjusted risk of FTR also increased in a stepwise fashion with increasing number of complications, reaching AOR (95% CI) of 2.25 (2.07, 2.45), p<0.001 for ≥ 4 complications.
Conclusion: The risk of failure to rescue increases with age and number of complications. Strategies which track this quality measure to encourage early recognition and treatment of complications in the elderly are necessary.
