Failure to Rescue Following Coronary Artery Bypass Grafting: Variation Within an Institution

S. Patlolla¹, A. Arghami², J. Stulak², J. K. Bohman², J. Crestanello², K. Holst^2
1Mayo Clinic, STATEN ISLAND, New York ²Mayo Clinic, Rochester, Minnesota

Purpose: Failure to rescue (FTR) is an important metric for improving perioperative care and has been identified as a key marker of institutional quality. We aimed to evaluate FTR and associated factors within a single, tertiary care center.

Methods: All consecutive adult patients undergoing isolated coronary artery bypass grafting (CABG) (N=7,056) and CABG with concomitant valve procedures (N=3,349) between January 2003 and December 2020 in our institution were identified. Patients undergoing concomitant non-valvular cardiac surgery, other than procedures for atrial fibrillation, were excluded. Patients of the study cohort (N=10,405) were reviewed to identify occurrence of postoperative complications and assess FTR, defined as early mortality following postoperative complications of stroke, renal failure, reoperation, and prolonged ventilation. Association of baseline and intra-operative characteristics with FTR was assessed using a multivariable logistic regression model with prespecified covariates.

Results: Within the study cohort, 13.2% (1376/10,405) had at least one of the specified complications in the postoperative period. Early mortality for isolated CABG was 1.6% (n=111) and for CABG plus valve surgery was 4.2% (n=142), with overall early mortality of 2.4% (n=253). Failure to rescue was 11.1% (82/737) for isolated CABG and 16.6% (106/639) for CABG plus valve surgery with overall FTR of 13.7% (n=188/1376). When none of the specified complications occurred, early mortality was 0.7% (n=65/9029); FTR following one, two, three, and four complications was 4.9% (n=48/979), 29.4% (n=91/309), 53.2% (n=42/79), and 77.8% (n=7/9), respectively. Among individual complications, renal failure had an FTR of 8.9% (9/101), stroke had a FTR of 6.3% (5/79), prolonged ventilation had an FTR of 4.5% (28/628), and reoperation had FTR of 3.5% (6/171). In a multivariable regression analysis, older age, prior cardiac surgery, and longer cardiopulmonary bypass times were associated with higher odds of FTR. Concomitant valve surgery, urgent/emergent procedures, and preoperative hospital admission were not associated with increased rates of FTR in multivariable modeling (Table).

Conclusion: Failure to rescue following CABG within our institution was higher in older patients following more complex procedures. Further assessment of FTR including patient, procedural, and institutional factors to analyze the complexity of these interactions will provide opportunities to further improve quality of patient care following cardiac surgery.

Identify the source of the funding for this research project: There was no funding for this study.