A. M. Stey1, T. Bongiovanni1, R. Callcut1 1University Of California San Francisco,Department Of Surgery,San Francisco, CA, USA
Introduction: Failure to rescue is an outcome measure more dependent on care related factors than other outcome measures. As such, failure to rescue may be a better means of targeting areas for improvement in quality of care. The aim of this study was to determine whether delayed exploratory laparotomy following traumatic injury was associated with higher failure to rescue rates postoperatively.
Methods: The National Trauma Data Bank (NTDB) National Sample Program 2008-2012 weighted file was used to identify patients older than 12 year of age that underwent exploratory laparotomy following injury. Delay was defined as greater than one day following presentation. A multi-level logistic model estimated the association between delay and failure to rescue while controlling for hypotension in the emergency room, Glasgow Coma Scale (GCS), Injury Severity Score and age at the patient level and hospital strata as well as response weight at the hospital level.
Results: A total of 2,245 patients underwent an exploratory laparotomy following traumatic injury. Of those, 5.5% experienced a delay greater than one day, despite the fact that 9.9% were hypotensive in the emergency room, 9.8% had a GCS of three and 16.5% had an Injury Severity Score greater than 25. In total, 31.2% of patients had a complication as defined in NTDB. The mortality rate overall was 9.8%. Failure to rescue occurred in 4.1% of patients. The average odds of failure to rescue if there was delayed exploratory laparotomy was 2.9 times higher than if there was no delay (95% confidence interval 1.3-6.2, p=0.0008) after adjusting for hypotension in the emergency room, GCS, injury severity score, age and hospital strata.
Conclusion: Operative delay greater than one day in exploratory laparotomy after traumatic injury was associated with significantly higher failure to rescue rates during their hospitalization. These findings could imply that, either that injury sets into motion pathophysiologic insults that cannot easily be reversed upon delayed exploration or possibly patients whose care is delayed initially may also be more likely to fail to be rescued from subsequent complications.