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Improving the Care of Elderly Adults Undergoing Surgery in Michigan
Author(s) -
Sheetz Kyle H.,
Guy Karen,
Allison James H.,
Barnhart Kara A.,
Hawken Scott R.,
Hayden Emily L.,
Starr Jordan B.,
Terjimanian Michael N.,
Waits Seth A.,
Mullard Andrew J.,
Krapohl Greta,
Ghaferi Amir A.,
Campbell Darrell A.,
Englesbe Michael J.
Publication year - 2014
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12643
Subject(s) - medicine , retrospective cohort study , cohort , emergency medicine , mortality rate , age groups , young adult , gerontology , demography , surgery , sociology
Objectives To determine whether failure to rescue, as a driver of mortality, can be used to identify which hospitals attenuate the specific risks inherent to elderly adults undergoing surgery. Design Retrospective cohort study. Setting State‐wide surgical collaborative in Michigan. Participants Older adults undergoing major general or vascular surgery between 2006 and 2011 (N = 24,216). Measurements Thirty‐four hospitals were ranked according to risk‐adjusted 30‐day mortality and grouped into tertiles. Within each tertile, rates of major complications and failure to rescue were calculated, stratifying outcomes according to age (<75 vs ≥75). Next, differences in failure‐to‐rescue rates between age groups within each hospital were calculated. Results Failure‐to‐rescue rates were more than two times as high in elderly adults as in younger individuals in each tertile of hospital mortality (26.0% vs 10.3% at high‐mortality hospitals, P < .001). Within hospitals, the average difference in failure‐to‐rescue rates was 12.5%. Nine centers performed better than expected, and three performed worse than expected, with the largest differences exceeding 25%. Conclusion Although elderly adults experience higher failure‐to‐rescue rates, this does not account for hospitals' overall capacity to rescue individuals from complications. Comparing rates of younger and elderly adults within hospitals may identify centers where efforts toward complication rescue favor, or are customized for, elderly adults. These centers should be studied as part of the collaborative's effort to address the disparate outcomes that elderly adults in Michigan experience.