Introduction
Quality improvement initiatives have focused primarily on preventing in-hospital complications.
Patients developing complications are at a greater risk of mortality; however, factors
associated with failure-to-rescue (death after major complication) in trauma patients
remain undefined. The aim of this study was to identify risk factors associated with
failure-to-rescue in patients undergoing trauma laparotomy.
Methods
An -8-year, retrospective analysis of patients undergoing trauma laparotomy was performed.
Patients who developed major in-hospital complications were included. Major complications
were defined as respiratory, infectious, cardiac, renal, or development of compartment
syndrome. Regression analysis was performed to identify independent factors associated
with failure-to-rescue after we adjusted for demographics, mechanism of injury, abdominal
abbreviated injury scale, initial vital signs, damage control laparotomy, and volume
of crystalloids and blood products administered.
Results
A total of 1,029 patients were reviewed, of which 21% (n = 217) patients who developed major complications were included. The mean age was
39 ± 18 years, 82% were male, 61% had blunt trauma, and median abdominal abbreviated
injury scale was 25 [16–34, interquartile range]. Respiratory complications (n = 77) followed by infectious complications (n = 75) were the most common complications. The failure-to-rescue rate was 15.7% (n = 34/217). Age, blunt trauma, severe head injury, uninsured status, and blood products
administered on the second day were independent predictor for failure-to-rescue.
Conclusion
When major complications develop, age, uninsured status, severity of head injury,
and prolonged resuscitation are associated independently with failure-to-rescue, whereas
initial resuscitation, coagulopathy, and acidosis did not predict failure to rescue.
Quality-of-care programs focus in patient level should be on improving the patient's
insurance status, preventing secondary brain injury, and further development of resuscitation
guidelines.
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Article info
Publication history
Published online: May 23, 2015
Accepted:
March 4,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
