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Failure to rescue as a patient safety indicator for neurosurgical patients: are we there yet? A systematic review

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Abstract

Failure to rescue (FTR) is a standardized patient safety indicator (PSI-04) developed by the Agency for Healthcare Research and Quality (AHRQ) to assess the ability of a healthcare team to prevent mortality following a major complication. However, FTR rates vary and are impacted by non-modifiable individual patient characteristics such as baseline frailty. This raises concerns regarding the validity of FTR as an objective quality metric, as not all patients have the same baseline frailty level, or physiological reserve, to recover from major complications. Literature from other surgical specialties has identified flaws in FTR and called for risk-adjusted metrics. Currently, knowledge of factors influencing FTR and its subsequent implementation in neurosurgical patients are limited. The present review assesses trends in FTR utilization to assess how FTR performs as an objective neurosurgery quality metric. This review then proposes how FTR may be best modified to optimize use in neurosurgical patients. A PubMed search was performed to identify articles published until August 9, 2023. Studies that reported FTR as an outcome in patients undergoing neurosurgical procedures were included. A qualitative assessment was performed using the Newcastle Ottawa Scale (NOS). The initial search revealed 1232 citations. After a title and abstract screen, followed by a full text screen, 12 studies met criteria for inclusion. These articles measured FTR across a total of 764,349 patients undergoing neurosurgical procedures. Five studies analyzed FTR with regard to hospital characteristics, and three studies utilized patient characteristics to predict FTR. All studies were considered high quality based on the NOS. Modifications in criteria to measure FTR are necessary since FTR depends on patient characteristics like frailty. This would allow for the incorporation of risk-adjusted FTR metrics that would aid in clinical decision making in neurosurgical patients.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Topiwala National Medical College, Mumbai, India

    Joanna M. Roy

  2. Bowers Neurosurgical Frailty and Outcomes Data Science Lab, Albuquerque, NM, 87131, USA

    Joanna M. Roy, Meic H. Schmidt & Christian A. Bowers

  3. Department of Neurosurgery, University of New Mexico Hospital (UNMH), 1 University New Mexico, MSC10 5615, Albuquerque, NM, 87131, USA

    Kavelin Rumalla, Georgios P. Skandalakis, Syed Faraz Kazim, Meic H. Schmidt & Christian A. Bowers

  4. Department of Neurosurgery, University of New Mexico Health Sciences Center, 1 University New Mexico, MSC10 5615, Albuquerque, NM, 81731, USA

    Christian A. Bowers

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Contributions

All authors contributed to the study conception and design. Joanna M. Roy, Kavelin Rumalla, and Georgios P. Skandalakis were involved in data collection. The first draft of the manuscript was written by Joanna M. Roy. Christian A. Bowers performed critical revision of the manuscript draft. All authors read and approved the final manuscript.

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Correspondence to Christian A. Bowers.

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Roy, J.M., Rumalla, K., Skandalakis, G.P. et al. Failure to rescue as a patient safety indicator for neurosurgical patients: are we there yet? A systematic review. Neurosurg Rev 46, 227 (2023). https://doi.org/10.1007/s10143-023-02137-7

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