World Journal of Surgery

, Volume 43, Issue 3, pp 910–919 | Cite as

Procedure-Specific Volume and Nurse-to-Patient Ratio: Implications for Failure to Rescue Patients Following Liver Surgery

  • Qinyu Chen
  • Griffin Olsen
  • Fabio Bagante
  • Katiuscha Merath
  • Jay J. Idrees
  • Ozgur Akgul
  • Jordan Cloyd
  • Mary Dillhoff
  • Susan White
  • Timothy M. PawlikEmail author
Original Scientific Report



The effect of various hospital characteristics on failure to rescue (FTR) after liver surgery has not been well examined. We sought to examine the relationship between hospital characteristics and FTR after liver surgery.


The 2013–2015 Medicare-Provider Analysis and Review (MEDPAR) database was used to identify Medicare beneficiaries who underwent liver surgery. The effect of various hospital characteristics on FTR was compared among the highest mortality hospitals (HMH) and the lowest mortality hospitals (LMH).


Among 4902 patients undergoing hepatectomy, patients treated at HMH had a higher risk of FTR (OR 3.08, 95% CI 2.03–4.66). Hospital factors such as total number of beds (OR 0.80, 95% 0.56–1.15), operating rooms (OR 0.81, 95% 0.57–1.14), and overall hospital surgical volume (OR 0.88, 95% 0.61–1.25) were not associated with FTR (all p > 0.05). In contrast, hospitals with a greater nurse-to-patient ratio had a markedly lower risk of FTR following a complication (OR 0.70, 95% CI 0.54–0.91; p = 0.007) (Table 3). As volume of liver operations and nurse-to-patient ratio decreased the risk of FTR increased (p > 0.001). After risk-adjusting for patient characteristics, both the effect of surgical volume (adjusted OR 0.66, 95% CI 0.46–0.94; p = 0.022) and nurse-to-patient ratio (adjusted OR 0.68, 95% CI 0.51–0.90; p = 0.008) remained strongly associated with FTR.


FTR rates varied considerably among hospital performing hepatectomy. Higher procedure-specific hepatectomy volume, as well as a higher nurse-to-patient ratio, accounted for a reduction in the FTR rates. These data highlight the importance of not only procedure volume, but also adequate nurse staffing in reducing FTR and improving mortality following complex procedures such as hepatectomy.


Compliance with ethical standards

Conflict of interest

All authors declare that they have no disclosures to report.

Supplementary material

268_2018_4859_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Qinyu Chen
    • 1
  • Griffin Olsen
    • 1
  • Fabio Bagante
    • 1
  • Katiuscha Merath
    • 1
  • Jay J. Idrees
    • 1
  • Ozgur Akgul
    • 1
  • Jordan Cloyd
    • 1
  • Mary Dillhoff
    • 1
  • Susan White
    • 1
  • Timothy M. Pawlik
    • 1
    • 2
    Email author
  1. 1.The Ohio State University Wexner Medical CenterColumbusUSA
  2. 2.Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer ResearchThe Ohio State University, Wexner Medical CenterColumbusUSA

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