Database : MEDLINE
Search on : H01.770.644.145.431.500 [DeCS Category]
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PMID:29229629
Author:Iacobucci G
Address:The BMJ.
Title:Student who died from anorexia was failed by NHS, review finds.
Source:BMJ; 359:j5731, 2017 12 11.
ISSN:1756-1833
Country of publication:England
Language:eng
Publication type:CASE REPORTS; NEWS


  2 / 41 MEDLINE  
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PMID:29245233
Author:Li S; Li Z; Hua W; Wang K; Li S; Zhang Y; Ye Z; Shao Z; Wu X; Yang C
Address:aDepartment of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and TechnologybDepartment of Orthopaedics, Wuhan General Hospital of Guangzhou Command, Wuhan, China.
Title:Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation: Case report and literature review.
Source:Medicine (Baltimore); 96(49):e8770, 2017 Dec.
ISSN:1536-5964
Country of publication:United States
Language:eng
Abstract:RATIONALE: Thoracic-lumbar vertebral fracture is very common in clinic, and late post-traumatic kyphosis is the main cause closely related to the patients' life quality, which has evocated extensive concern for the surgical treatment of the disease. This study aimed to analyze the clinical outcomes and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation. PATIENT CONCERNS: All patients presented back pain with kyphotic apex vertebrae between T12 and L3. According to Frankel classification grading system, among them, 3 patients were classified as grade D, with the ability to live independently. DIAGNOSES: A systematic review of 12 case series of post-traumatic kyphosis after failed thoracolumbar fracture operation was involved. INTERVENTIONS: Wedge osteotomy was performed as indicated-posterior closing osteotomy correction in 5 patients and anterior open-posterior close correction in 7 patients.Postoperatively, thoracolumbar x-rays were obtained to evaluate the correction of kyphotic deformity, visual analog scales (VAS) and Frankel grading system were used for access the clinical outcomes. OUTCOMES: All the patients were followed up, with the average period of 38.5 months (range 24-56 months). The Kyphotic Cobb angle was improved from preoperative (28.65 ±â€Š11.41) to postoperative (1.14 ±â€Š2.79), with the correction rate of 96.02%. There was 1 case of intraoperative dural tear, without complications such as death, neurological injury, and wound infection. According to Frankel grading system, no patient suffered deteriorated neurological symptoms after surgery, and 2 patients (2/3) experienced significant relief after surgery. The main VAS score of back pain was improved from preoperative (4.41 ±â€Š1.08) to postoperative (1.5 ±â€Š0.91) at final follow-up, with an improvement rate of 65.89%. LESSONS: Surgical treatment of late post-traumatic kyphosis after failed thoracolumbar fracture operation can obtain good radiologic and clinical outcomes by kyphosis correction, decompression, and posterior stability.
Publication type:JOURNAL ARTICLE; REVIEW


  3 / 41 MEDLINE  
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PMID:28859006
Author:Bacon CT
Address:School of Nursing, The University of North Carolina at Greensboro.
Title:Nurses to Their Nurse Leaders: We Need Your Help After a Failure to Rescue Patient Death.
Source:Nurs Adm Q; 41(4):368-375, 2017 Oct/Dec.
ISSN:1550-5103
Country of publication:United States
Language:eng
Abstract:The purpose of this study was to describe nurses' needs and how they are being met and not met after caring for surgical patients who died after a failure to rescue (FTR). A qualitative, phenomenologic approach was used for the interview and analysis framework. Methods to ensure rigor and trustworthiness were incorporated into the design. The investigator conducted semistructured 1:1 interviews with 14 nurses. Data were analyzed using Colaizzi's methods. Four themes were identified: (1) coping mechanisms are important; (2) immediate peer and supervisor feedback and support are needed for successful coping; (3) subsequent supervisor support is crucial to moving on; and (4) nurses desire both immediate support and subsequent follow-up from their nurse leaders after every FTR death. Nurses' needs after experiencing an FTR patient death across multiple practice areas and specialties were remarkably similar and clearly identified and articulated. Coping mechanisms vary and are not uniformly effective across different groups. Although most nurses in this study received support from their peers after the FTR event, many nurses did not receive the feedback and support that they needed from their nurse leaders. Immediate nurse leader support and follow-up debriefings should be mandatory after patient FTR deaths. Developing an understanding of nurses' needs after experiencing an FTR event can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths also provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.
Publication type:JOURNAL ARTICLE


  4 / 41 MEDLINE  
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PMID:28797755
Author:Busweiler LA; Henneman D; Dikken JL; Fiocco M; van Berge Henegouwen MI; Wijnhoven BP; van Hillegersberg R; Rosman C; Wouters MW; van Sandick JW; Dutch Upper GI Cancer Audit group
Address:Dutch Institute for Clinical Auditing, Leiden, The Netherlands; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: l.a.d.busweiler@lumc.nl.
Title:Failure-to-rescue in patients undergoing surgery for esophageal or gastric cancer.
Source:Eur J Surg Oncol; 43(10):1962-1969, 2017 Oct.
ISSN:1532-2157
Country of publication:England
Language:eng
Abstract:BACKGROUND: Complex surgical procedures such as esophagectomy and gastrectomy for cancer are associated with substantial morbidity and mortality. The purpose of this study was to evaluate trends in postoperative morbidity, mortality, and associated failure-to-rescue (FTR), in patients who underwent a potentially curative resection for esophageal or gastric cancer in the Netherlands, and to investigate differences between the two groups. METHODS: All patients with esophageal or gastric cancer who underwent a potentially curative resection, registered in the Dutch Upper GI Cancer Audit (DUCA) between 2011 and 2014, were included. Primary outcomes were (major) postoperative complications, postoperative mortality and FTR. To investigate groups' effect on the outcomes of interest a mixed model was used. RESULTS: Overall, 2644 patients with esophageal cancer and 1584 patients with gastric cancer were included in this study. In patients with gastric cancer, postoperative mortality (7.7% in 2011 vs. 3.8% in 2014) and FTR (38% in 2011 and 19% in 2014) decreased significantly over the years. The adjusted risk of developing a major postoperative complication was lower (OR 0.54; 95% CI 0.42-0.70), but the risk of FTR was higher (OR 1.85; 95% CI 1.05-3.27) in patients with gastric cancer compared to patients with esophageal cancer. CONCLUSION: Once a postoperative complication occurred, patients with gastric cancer were more likely to die compared to patients with esophageal cancer. Underlying mechanisms like patient selection, and differences in structure and organization of care should be investigated. Next to morbidity and mortality, failure-to-rescue should be considered as an important outcome measure after esophagogastric cancer resections.
Publication type:JOURNAL ARTICLE; MULTICENTER STUDY


  5 / 41 MEDLINE  
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PMID:28624046
Author:Li KY; Mokdad AA; Minter RM; Mansour JC; Choti MA; Augustine MM; Polanco PM
Address:Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
Title:Failure to rescue following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Source:J Surg Res; 214:209-215, 2017 Jun 15.
ISSN:1095-8673
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) can significantly improve the survival in selected patients with peritoneal carcinomatosis. This study aims to identify perioperative patient characteristics predictive of failure to rescue (FTR), mortality following postoperative complications from CRS/HIPEC. METHODS: Patients suffering a complication following CRS/HIPEC between 2005 and 2013 were identified in the American College of Surgeons National Surgical Quality Improvement Program data set. FTR was defined as 30-d mortality in the setting of a complication. Patients who suffered FTR were compared against those who survived a complication (non-FTR). Predictors of FTR were identified using a multivariable logistic regression model. RESULTS: A total of 915 eligible CRS/HIPEC cases were identified. In all, 382 patients (42%) developed ≥1 postoperative complication, and 88 patients (10%) suffered ≥1 major complication. Seventeen patients died following a complication, amounting to an FTR rate of 4%. FTR patients were more likely than non-FTR patients to have dependent functional status (18% versus 2%, P = 0.01), have American Society of Anesthesiologists (ASA) class 4 status (29% versus 8%, P = 0.01), develop ≥3 complications (65% versus 24%, P < 0.01), and suffer a major complication (94% versus 20%, P < 0.01). The following were independently associated with FTR: ASA class 4 (odds ratio [OR]: 13.4, 95% confidence interval [CI], 1.2-146.8) and major complications (OR: 66.0, 95% CI, 8.4-516.6). CONCLUSIONS: ASA class 4, major morbidity, and likely dependent functional status are independent predictors of FTR following CRS/HIPEC to treat peritoneal carcinomatosis. Therefore, ASA class 4 and dependent functional status should be considered as contraindications for CRS/HIPEC and only offered in highly selective cases.
Publication type:JOURNAL ARTICLE


  6 / 41 MEDLINE  
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PMID:28624034
Author:Varley PR; Geller DA; Tsung A
Address:Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Electronic address: varleypr@upmc.edu.
Title:Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective.
Source:J Surg Res; 214:131-139, 2017 Jun 15.
ISSN:1095-8673
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Failure to rescue is the concept of death after a complication, and it is an important factor driving variation in mortality rates after pancreatic surgery. The purpose of this study was to conduct a retrospective review of a large, multi-institutional data set to describe patient-level risk factors for failure to rescue in greater detail. METHODS: From the American College of Surgeons National Surgical Quality Improvement Program participant use file, 14,557 patients who underwent pancreaticoduodenectomy were identified. Of these, 4514 experienced at least one complication and were therefore at risk for failure to rescue. Multivariable logistic regression models to identify factors independently associated with failure to rescue. RESULTS: Age, American Society of Anesthesiologists class, ascites and/or varices, and disseminated malignancy were significant independent risk factors for failure to rescue. Participation of a resident was associated with reduced odds of failure to rescue. Patients who experienced an initial complication and then accumulated additional complications were more common in the failure to rescue group (68.6% versus 31.3%, P < 0.001). CONCLUSIONS: Accumulation of complications after pancreaticoduodenectomy is a significant risk factor for failure to rescue. Pancreatic surgery quality improvement programs should continue developing strategies to identify and intervene on post-pancreatectomy complications, especially in high-risk patients.
Publication type:JOURNAL ARTICLE


  7 / 41 MEDLINE  
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PMID:28433333
Author:Rosero EB; Joshi GP; Minhajuddin A; Timaran CH; Modrall JG
Address:Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Tex. Electronic address: eric.rosero@utsouthwestern.edu.
Title:Effects of hospital safety-net burden and hospital volume on failure to rescue after open abdominal aortic surgery.
Source:J Vasc Surg; 66(2):404-412, 2017 Aug.
ISSN:1097-6809
Country of publication:United States
Language:eng
Abstract:OBJECTIVE: Failure to rescue (FTR) is defined as the inability to rescue a patient from major perioperative complications, resulting in operative mortality. FTR is a known contributor to operative mortality after open abdominal aortic surgery. Understanding the causes of FTR is essential to designing interventions to improve perioperative outcomes. The objective of this study was to determine the relative contributions of hospital volume and safety-net burden (the proportion of uninsured and Medicaid-insured patients) to FTR. METHODS: The Nationwide Inpatient Sample (2001-2011) was analyzed to investigate variables associated with FTR after elective open abdominal aortic operations in the United States. FTR was defined as in-hospital death following postoperative complications. Mixed multivariate regression models were used to assess independent predictors of FTR, taking into account the clustered structure of the data (patients nested into hospitals). RESULTS: A total of 47,233 elective open abdominal aortic operations were performed in 1777 hospitals during the study period. The overall incidences of postoperative complications, in-hospital mortality, and FTR in the whole cohort were 32.7%, 3.2%, and 8.6%, respectively. After adjusting for demographics, comorbidities, and hospital characteristics, safety-net burden was significantly associated with increased likelihood of FTR (highest vs lowest quartile of safety-net burden, odds ratio, 1.59; 95% confidence interval, 1.32-1.91; P < .0001). In contrast, after adjusting for safety-net burden, procedure-specific hospital volume was not significantly associated with FTR (P = .897). CONCLUSIONS: After adjusting for patient- and hospital-level variables, including hospital volume, safety-net burden was an independent predictor of FTR after open aortic surgery. Future investigations should be aimed at better understanding the relationship between safety-net hospital burden and FTR to design interventions to improve outcomes after open abdominal aortic surgery.
Publication type:JOURNAL ARTICLE


  8 / 41 MEDLINE  
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PMID:28277768
Author:Patel S; Gillon SA; Jones DA
Address:ST1 Radiology Registrar, Radiology Department, Guys Hospital, London SE1 9RT.
Title:Rapid response systems: recognition and rescue of the deteriorating hospital patient.
Source:Br J Hosp Med (Lond); 78(3):143-148, 2017 Mar 02.
ISSN:1750-8460
Country of publication:England
Language:eng
Abstract:The last 25 years have witnessed significant change in the approach to the deteriorating patient. This article reviews and discusses the merits and drawbacks of the various systems used across the world.
Publication type:JOURNAL ARTICLE


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PMID:28202161
Author:Kauvar DS; Martin ED; Simon TE; Givens MD
Address:Vascular Surgery Service, Dwight D. Eisenhower Army Medical Center, Ft. Gordon, GA, USA; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Electronic address: davekauvar@gmail.com.
Title:Complication profile, failure to rescue, and mortality following elective endovascular aortic aneurysm repair.
Source:Am J Surg; 214(2):307-311, 2017 Aug.
ISSN:1879-1883
Country of publication:United States
Language:eng
Abstract:INTRODUCTION: Understanding the relationship between patient risk factors, postoperative complications, and morbidity and mortality is important when considering elective endovascular aortic aneurysm repair (E-EVAR) performed to prevent aneurysm rupture mortality. We aimed to stratify complications in E-EVAR and explore their relationship with postoperative death. METHODS: E-EVAR cases from 2012 NSQIP were identified. 30-day complications were categorized as major (MAJCX) or minor (MINCX) using the Clavien-Dindo classification. Failure to rescue (FTR) was defined as death following a complication. Univariate and multivariate analyses were performed to identify associations between patient risk factors, complications, and mortality. Significance set at P < 0.05. RESULTS: 3344 E-EVAR's were analyzed, with 155 (4.6%) MINCX, 106 (3.2%) MAJCX, and 39 (1.2%) mortality. Significant univariate risk factors differed between MINCX (preoperative dyspnea 27% vs 19%, COPD 32% vs19%, HTN 87% vs 79%, functional dependence 9% vs 3%) and MAJCX (female sex 33% vs 18%, preoperative diabetes 30% vs 17%, dyspnea 40% vs 19%, COPD 46% vs 20%, anticoagulant use 20% vs 11%, and functional dependence 13% vs 3%). 24 of 39 (62%) of deaths were preceded by a complication. FTR was more frequent following MAJCX than MINCX (16% vs 4.5%, P = 0.002), and occurred most commonly after renal failure with dialysis (33% mortality with complication), cardiac arrest (33%), septic shock (22%), and reintubation (22%). Independent predictors of MAJCX included female sex (OR 2, P = 0.001), COPD (OR 2, P = 0.009), and anticoagulant use (OR 2, P = 0.001). Mortality was independently predicted by MAJCX (OR 29, P < 0.001), MINCX (OR 8, P < 0.001), and preoperative renal failure (OR 11.6, P < 0.001). CONCLUSION: The majority of deaths within 30 days following E-EVAR are preceded by a complication; both MAJCX and MINCX predict mortality. FTR is more common after MAJCX; prevention efforts should take this into account. Identified risk factors should be taken into consideration when considering E-EVAR.
Publication type:JOURNAL ARTICLE


  10 / 41 MEDLINE  
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PMID:27788924
Author:Kuo LE; Kaufman E; Hoffman RL; Pascual JL; Martin ND; Kelz RR; Holena DN
Address:Department of Surgery, Center for Surgery and Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: Lindsay.kuo@uphs.upenn.edu.
Title:Failure-to-rescue after injury is associated with preventability: The results of mortality panel review of failure-to-rescue cases in trauma.
Source:Surgery; 161(3):782-790, 2017 Mar.
ISSN:1532-7361
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Failure-to-rescue is defined as the conditional probability of death after a complication, and the failure-to-rescue rate reflects a center's ability to successfully "rescue" patients after complications. The validity of the failure-to-rescue rate as a quality measure is dependent on the preventability of death and the appropriateness of this measure for use in the trauma population is untested. We sought to evaluate the relationship between preventability and failure-to-rescue in trauma. METHODS: All adjudications from a mortality review panel at an academic level I trauma center from 2005-2015 were merged with registry data for the same time period. The preventability of each death was determined by panel consensus as part of peer review. Failure-to-rescue deaths were defined as those occurring after any registry-defined complication. Univariate and multivariate logistic regression models between failure-to-rescue status and preventability were constructed and time to death was examined using survival time analyses. RESULTS: Of 26,557 patients, 2,735 (10.5%) had a complication, of whom 359 died for a failure-to-rescue rate of 13.2%. Of failure-to-rescue deaths, 272 (75.6%) were judged to be non-preventable, 65 (18.1%) were judged potentially preventable, and 22 (6.1%) were judged to be preventable by peer review. After adjusting for other patient factors, there remained a strong association between failure-to-rescue status and potentially preventable (odds ratio 2.32, 95% confidence interval, 1.47-3.66) and preventable (odds ratio 14.84, 95% confidence interval, 3.30-66.71) judgment. CONCLUSION: Despite a strong association between failure-to-rescue status and preventability adjudication, only a minority of deaths meeting the definition of failure to rescue were judged to be preventable or potentially preventable. Revision of the failure-to-rescue metric before use in trauma care benchmarking is warranted.
Publication type:JOURNAL ARTICLE



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