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Comment & Response
July 2014

Failure to Rescue—Reply

Author Affiliations
  • 1Center for Healthcare Outcomes and Policy, Department of Surgery, University of Michigan, Ann Arbor
  • 2Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago
JAMA Surg. 2014;149(7):748-749. doi:10.1001/jamasurg.2014.592

In Reply We appreciate Dr Silber’s thoughtful letter. His insights and efforts have laid the foundation for failure to rescue (FTR) as an important measure of surgical quality.1 First, we understand Dr Silber’s concern regarding not counting known deaths. However, we would like to clarify that these patients were included in our overall calculation of postoperative mortality but excluded from our calculation of complication and FTR rates. Second, he asked whether the inclusion of patients with an acute myocardial infarction would alter our findings. As noted in our Table 2 reporting complication and FTR rates, we excluded patients with an International Classification of Diseases, Ninth Revision, Clinical Modification code for myocardial infarction who underwent coronary artery bypass grafting.2 Conversely, inclusion of these patients did not qualitatively change the findings presented therein. Comparing complications after coronary artery bypass grafting at low- and high-volume hospitals, we found that the inclusion of patients with a myocardial infarction resulted in rates of 43.6% and 42.4%, respectively (odds ratio, 1.06 [95% CI, 1.02-1.09]). Similarly, including these patients did not result in clinically meaningful differences in the relationship between volume and FTR rate (8.6% in low-volume hospitals vs 7.4% in high-volume hospitals; odds ratio, 1.17 [95% CI, 1.08-1.27]).

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