Evidence map›Paper›PMID 37977874›Full record

Observational studyBMJ open2023

Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study.

Knut Magne Augestad, Katrine Damgaard Skyrud, Anne Karin Lindahl, Jon Helgeland

Open access · goldAbstract readObservational Study
In one paragraph

Observational study in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
1.3field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.

  1. Pooled it
  2. Observational
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 1 country.

Knut Magne AugestadDivision of Surgery Campus Ahus, University of Oslo, Oslo, Norway k.m.augestad@medisin.uio.no.ORCID 0000-0002-4093-652X
Katrine Damgaard SkyrudCluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway.
Anne Karin LindahlDivision of Surgery, Akershus Hospital Trust, Oslo, Norway.
Jon HelgelandCluster for Health Services Research, Norwegian Institute of Public Health, Oslo, Norway.ORCID 0000-0002-9348-7844
Norwegian Institute of Public Health · NOAkershus University Hospital · NOUniversity Hospital of North Norway · NO

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThis study aims to determine hospital variation and intensive care unit characteristics associated with failure to rescue after abdominal surgery in Norway.

designA nationwide retrospective observational study.

settingAll 52 hospitals in Norway performing elective and acute abdominal surgery.

participantsAll 598 736 patients undergoing emergency and elective abdominal surgery from 2011 to 2021. PRIMARY OUTCOME MEASURE: Primary outcome was failure to rescue within 30 days (FTR30), defined as in-hospital or out-of-hospital death within 30 days of a surgical patient who developed at least one complication within 30 days of the surgery (FTR30). Other outcome variables were surgical complications and hospital FTR30 variation. Statistical analysis was conducted separately for general surgery and abdominal surgery.

resultsThe 30-day postoperative complication rate was 30.7 (183 560 of 598 736 surgeries). Of general surgical complications (n=25 775), circulatory collapse (n=6127, 23%), cardiac arrhythmia (n=5646, 21%) and surgical infections (n=4334, 16 %) were most common and 1507 (5.8 %) patients were reoperated within 30 days. One thousand seven hundred and forty patients had FTR30 (6.7 %). The severity of complications was strongly associated with FTR30. In multivariate analysis of general surgery, adjusted for patient characteristics, only the year of surgery was associated with FTR30, with an estimated linear trend of -0.31 percentage units per year (95% CI (-0.48 to -0.15)). The driving distance from local hospitals to the nearest referral intensive care unit was not associated with FTR30. Over the last decade, FTR30 rates have varied significantly among similar hospitals.

conclusionsHospital factors cannot explain Norwegian hospitals' significant FTR variance when adjusting for patient characteristics. The national FTR30 measure has dropped around 30% without a corresponding fall in surgical complications. No association was seen between rural hospital location and FTR30. Policy-makers must address microsystem issues causing high FTR30 in hospitals.

Indexed as

HospitalsPostoperative ComplicationsElective Surgical ProceduresHospital MortalityHumansIntensive Care UnitsRetrospective Studiesgastrointestinal tumourshealth services administration & managementquality in health care

Identifiers

PMID37977874
PMCPMC10661059
OpenAlexW4388783764

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.