Failure To Rescue After Complications Defines Lung Cancer Resection Survival

By Lynda Williams, Senior medwireNews Reporter

The variation in mortality rates among patients undergoing lung cancer resection in US hospitals has been attributed by a cohort study to differences in failure-to-rescue (FTR) rates after the development of complications.

“Thus, a better understanding of the cause of failure to rescue may be crucial for improving mortality rates following lung cancer resection”, the study authors suggest in JAMA Surgery.

Data were collated on 441 lung cancer surgeries performed between 2006 and 2007 in 18 hospitals designated by the Commission on Cancer as being low-mortality hospitals (LMHs) and 204 procedures performed in 25 hospitals designated as high-mortality hospitals (HMHs).

After adjusting for a raft of patient and cancer risk factors, the researchers confirmed mortality rates were significantly different in the LMHs and HMHs, at 1.8% versus 8.1%.

But the team, led by Tyler Grenda, from the University of Michigan in Ann Arbor, USA, reports that the overall complication rate was comparable in LMHs and HMHs (23.3 vs 15.6%), with no significant differences in the rate of medical or surgical complications. There were also comparable rates of cardiopulmonary events in LMHs and HMHs, although HMHs had a higher rate of other types of complications.

However, the FTR rate after complications was significantly lower in LMHs than HMHs, at 8.7% versus 25.9%, making the case fatality rate 6.55-times higher in HMHs.

“This finding emphasizes the need for a better understanding of the factors related to complications following lung cancer operations and their subsequent management to identify areas that may have the most powerful effect on quality improvement”, the authors conclude.

Thomas Varghese Jr, from the University of Utah School of Medicine in Salt Lake City, USA, observes in a related commentary that the difference in mortality rates for surgical procedures is “often related to what hospital systems do after complication occurs.”

He concludes: “Endorsed by the National Quality Forum and Agency for Healthcare Research and Quality, FTR assessment should become the norm for all procedures because of its focus on hospital actions identifying complications quickly and treating them aggressively.

“Indeed, it is a needed fresh breath of air in the field of thoracic surgery.”

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