B. Zangbar1, B. Joseph1, V. Pandit1, N. Kulvatunyou1, T. O’keeffe1, M. Khalil1, A. Tang1, G. Vercruysse1, R. Latifi1, R. S. Friese1, P. Rhee1 1University Of Arizona,Trauma/Surgery/Medicine,Tucson, AZ, USA
Introduction: Quality improvement initiatives have primarily focused on preventing in-hospital complications. Patients developing complications are at a higher 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 adjusting for demographics, mechanism of injury, abbreviated injury scales (AIS), initial vital signs, performance of 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 a-AIS was 25 [16-34]. Respiratory complications (35.4%, n=77) followed by infectious complications (45.1%, n=98) were the most common major complications. The mortality rate was 15.7% (n=34). Blunt trauma, severe head injury, uninsured status, and blood products administered on the second day were independent predictors for failure-to-rescue. The overall failure-to-rescue rate was 3.3%.
Conclusion: The overall failure-to-rescue rate was low (3.3%) in patients undergoing trauma laparotomy. However, when major complications develop, uninsured status, severity and mechanism of injury, and blood product requirement are independently associated with failure-to-rescue.
