Surgical outcomes and failure-to-rescue events after colectomy in teaching hospitals: a nationwide analysis

Background The relationship between failure-to-rescue (FTR) after colectomy is not well understood, particularly in teaching institutions. We sought to examine this relationship using a large national database. Methods Patients undergoing colectomy from 2010 to 2012 were identified in the Nationwide Inpatient Sample database. FTR events were defined as deaths following deep vein thrombosis or pulmonary embolism, sepsis, gastrointestinal bleed, acute myocardial infarction, acute kidney injury, pneumonia, respiratory failure, shock. We compared outcomes between teaching hospitals (TH) and nonteaching hospitals (NTH). Results A total of 220,369 patients underwent colectomy; 50.2% were performed at TH. Overall mortality was 3.7% with 96% of deaths attributed to at least one FTR event. More complications occurred in NTH, but there was no difference in mortality or FTR rates. However, TH had higher incidences of deep vein thrombosis or pulmonary embolism and sepsis leading to postoperative mortality, whereas NTH had higher rates of acute myocardial infarction and gastrointestinal bleed. Conclusions A substantial proportion of mortality is attributed to FTR events after colectomy in both TH and NTH. Further investigation targeting specific complications is warranted.