Incidence of failure-to-rescue after coronary artery bypass grafting: a multicenter observational study from the REPLICCAR II registry in Brazil.

IF 2.1 Q1 SURGERY Patient Safety in Surgery Pub Date : 2025-02-11 DOI:10.1186/s13037-024-00417-9

Gabrielle Barbosa Borgomoni, Roger Daglius Dias, Pedro Gabriel Melo de Barros E Silva, Marcelo Arruda Nakazone, Marco Antonio Praça de Oliveira, Valquíria Pelisser Campagnucci, Marcos Gradim Tiveron, Luís Augusto Ferreira Lisboa, Ludhmila Abrahão Hajjar, Jorge Passamani Zubelli, Fábio Biscegli Jatene, Omar Asdrúbal Vilca Mejia

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Abstract

Background: Failure-to-rescue refers to the rate of failure amongst healthcare teams in reversing complications that occur during a patient's hospitalization. This study aimed to investigate the failure-to-rescue rate following coronary artery bypass grafting (CABG).

Methods: Cross-sectional cohort study of the multicenter database "Registro Paulista de Cirurgia Cardiovascular II" (REPLICCAR II), which includes data from nine reference centers for cardiac surgery in São Paulo State. The study population included patients > 18 years of age who had undergone primary and isolated CABG surgery between 2017 and 2019 in Brazil. The outcome measured was failure-to-rescue (including death and the development of postoperative complications: prolonged ventilation time, stroke, reoperation, and kidney injury). The study used the Society of Thoracic Surgeons (STS) risk score to calculate the expected complication rates.

Results: Out of the 3964 patients, 439 developed one or more of the analyzed complications, and out of those, 94 died (2.37% of the full sample). The standardized mortality ratio (SMR) for patients who developed one complication was 8.84% (10.7%/1.21%), whereas those with two combinations of complications had an SMR of 32.34% (53.68%/1.66%) and three complications had an SMR of 42.02% (50%/1.19%). However, patients who progressed without the analyzed complications had an SMR of 0.95% (0.74%/0.80%).

Conclusion: The REPLICCAR II database revealed a failure-to-rescue rate of 21.41% (94/439), and the SMR increased progressively according to the greater number of complications. Our findings emphasize the need to measure the impact of early diagnosis and effective hospital team response by parameterizing the risk of expected death after severe complications.

Trial registration: The REPLICCAR Registry and The Statewide Quality Improvement Initiative, ID NCT05363696.

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冠状动脉旁路移植术后抢救失败的发生率：来自巴西REPLICCAR II登记的一项多中心观察性研究

背景：抢救失败是指医疗团队在逆转患者住院期间发生的并发症方面的失败率。本研究旨在探讨冠状动脉旁路移植术（CABG）后的抢救失败率。方法：对多中心数据库“Registro Paulista de Cirurgia Cardiovascular II”（REPLICCAR II）进行横断面队列研究，该数据库包括来自圣保罗州9个心脏外科参考中心的数据。研究人群包括2017年至2019年在巴西接受过原发性和孤立性冠脉搭桥手术的18岁至18岁的患者。测量的结果是抢救失败（包括死亡和术后并发症的发生：延长通气时间、卒中、再手术和肾损伤）。该研究使用胸外科学会（STS）风险评分来计算预期的并发症发生率。结果：在3964例患者中，439例出现了一种或多种分析并发症，其中94例死亡（占全部样本的2.37%）。合并一种并发症的患者标准化死亡率（SMR）为8.84%(10.7%/1.21%)，合并两种并发症的患者标准化死亡率为32.34%(53.68%/1.66%)，合并三种并发症的患者标准化死亡率为42.02%（50%/1.19%）。然而，没有分析并发症的进展患者的SMR为0.95%（0.74%/0.80%）。结论：REPLICCAR II数据库显示抢救失败率为21.41% (94/439)，SMR随着并发症数量的增加而逐渐增加。我们的研究结果强调需要通过参数化严重并发症后预期死亡的风险来衡量早期诊断和有效的医院团队反应的影响。试验注册：REPLICCAR注册和全州质量改进倡议，ID NCT05363696。

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