@article{oai:tsukuba.repo.nii.ac.jp:02001510,
 author = {Abe, Toshikazu and Komori, Akira and Shiraishi, Atsushi and 杉山, 雄大 and SUGIYAMA, Takehiro and Iriyama, Hiroki and Kainoh, Takako and Saitoh, Daizoh},
 issue = {1},
 journal = {Critical Care},
 month = {May},
 note = {Background: Reducing medical errors and minimizing complications have become the focus of quality improvement
in medicine. Failure-to-rescue (FTR) is defined as death after a surgical complication, which is an institution-level
surgical safety and quality metric that is an important variable affecting mortality rates in hospitals. This study aims to
examine whether complication and FTR are different across low- and high-mortality hospitals for trauma care.

Methods: This was a retrospective cohort study performed at trauma care hospitals registered at Japan Trauma Data
Bank (JTDB) from 2004 to 2017. Trauma patients aged ≥ 15 years with injury severity score (ISS) of ≥ 3 and those who
survived for > 48 h after hospital admission were included. The hospitals in JTDB were categorized into three groups by
standardized mortality rate. We compared trauma complications, FTR, and in-hospital mortality by a standardized
mortality rate (divided by the institute-level quartile).

Results: Among 184,214 patients that were enrolled, the rate of any complication was 12.7%. The overall mortality rate
was 3.7%, and the mortality rate among trauma patients without complications was only 2.8% (non-precedented deaths).
However, the mortality rate among trauma patients with any complications was 10.2% (FTR). Hospitals were categorized
into high- (40 facilities with 44,773 patients), average- (72 facilities with 102,368 patients), and low- (39 facilities with 37,073
patients) mortality hospitals, using the hospital ranking of a standardized mortality rate. High-mortality hospitals showed
lower ISS than low-mortality hospitals [10 (IQR, 9–18) vs. 11 (IQR, 9–20), P < 0.01]. Patients in high-mortality hospitals
showed more complications (14.2% vs. 11.2%, P < 0.01), in-hospital mortality (5.1% vs. 2.5%, P < 0.01), FTR (13.6% vs. 7.4%,
P < 0.01), and non-precedented deaths (3.6% vs. 1.9%, P < 0.01) than those in low-mortality hospitals.

Conclusions: Unlike reports of elective surgery, complication rates and FTR are associated with in-hospital mortality rates
at the center level in trauma care.},
 title = {Trauma complications and in-hospital mortality: failure-to-rescue},
 volume = {24},
 year = {2020},
 yomi = {スギヤマ, タケヒロ}
}