Failure to rescue: A candidate quality metric for durable left ventricular assist device implantation

Michael J Pienta; Thomas M Cascino; Donald S Likosky; Amir A Ghaferi; Keith D Aaronson; Francis D Pagani; Michael P Thompson; Michigan Congestive Heart Failure Investigators

doi:10.1016/j.jtcvs.2021.10.054

Failure to rescue: A candidate quality metric for durable left ventricular assist device implantation

J Thorac Cardiovasc Surg. 2023 Jun;165(6):2114-2123.e5. doi: 10.1016/j.jtcvs.2021.10.054. Epub 2021 Nov 9.

Authors

Michael J Pienta¹, Thomas M Cascino², Donald S Likosky³, Amir A Ghaferi⁴, Keith D Aaronson², Francis D Pagani³, Michael P Thompson³; Michigan Congestive Heart Failure Investigators

Collaborators

Michigan Congestive Heart Failure Investigators:
Donald S Likosky, Francis D Pagani, Ashraf Shaaban Abdel Aziz Abou El Ela, Paul C Tang, Michael P Thompson, Keith Aaronson, Supriya Shore, Thomas Cascino, Katherine B Salciccioli, Min Zhang, Jeffrey S McCullough, Michelle Hou, Allison M Janda, Michael R Mathis, Tessa M F Watt, Michael J Pienta, Alexander Brescia, Austin Airhart, Daniel Liesman, Khalil Nassar

Affiliations

¹ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich. Electronic address: mpienta@med.umich.edu.
² Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Mich.
³ Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
⁴ Department of Surgery, University of Michigan, Ann Arbor, Mich.

PMID: 34887093
PMCID: PMC9081291 (available on 2024-06-01)
DOI: 10.1016/j.jtcvs.2021.10.054

Abstract

Objective: Failure to rescue (FTR), defined as death after a complication, is recognized as a principal driver of variation in mortality among hospitals. We evaluated FTR as a quality metric in patients who received durable left ventricular assist devices (LVADs) using the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support.

Methods: Data on 13,617 patients who received primary durable LVADs from April 2012 to October 2017 at 131 hospitals that performed at least 20 implants were analyzed from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support. Rates of major complications and FTR were compared across risk-adjusted in-hospital mortality terciles (low, medium, high) and hospital volume. Logistic regression was used to estimate expected FTR rates on the basis of patient factors for each major complication.

Results: The overall unadjusted in-hospital mortality rate was 6.96%. Risk-adjusted in-hospital mortality rates varied 3.1-fold across terciles (low, 3.3%; high, 10.3%; P trend <.001). Rates of major complications varied 1.1-fold (low, 34.0%; high, 38.8%; P < .0001). Among patients with a major complication, 854 died in-hospital for an FTR rate of 17.7%, with 2.8-fold variation across mortality terciles (low, 8.5%; high, 23.9%; P < .0001). FTR rates were highest for renal dysfunction requiring dialysis (45.3%) and stroke (36.5%). Higher average annual LVAD volume was associated with higher rates of major complications (<10 per year, 26.7%; 10-20 per year, 34.0%; 20-30 per year, 34.0%; >30 per year, 40.1%; P trend <.0001) whereas hospitals implanting <10 per year had the highest FTR rate (<10 per year, 23.5%; 10-20 per year, 16.5%; 20-30 per year, 17.0%; >30 per year, 17.9%; P = .03).

Conclusions: FTR might serve as an important quality metric for durable LVAD implant procedures, and identifying strategies for successful rescue after complications might reduce hospital variations in mortality.

Keywords: LVAD; complications; failure to rescue; left ventricular assist device; mortality.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Heart-Assist Devices* / adverse effects
Hospital Mortality
Hospitals
Humans
Postoperative Complications
Renal Dialysis
Retrospective Studies
Thoracic Surgical Procedures*

Abstract

Publication types

MeSH terms

Grants and funding