Failure to Rescue – A Candidate Quality Metric for Durable Left Ventricular Assist Device Implantation

Abstract Objective Failure to rescue (FTR), defined as death after a complication, is recognized as a principal driver of variation in mortality among hospitals. We evaluated FTR as a quality metric in patients receiving durable LVADs using The Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (STS-Intermacs). Methods Data were analyzed from STS-Intermacs on 13,617 patients receiving primary durable LVADs from 04/2012 to 10/2017 at 131 hospitals performing at least 20 implants. Rates of major complications and FTR were compared across risk-adjusted in-hospital mortality terciles (low, medium, high) and hospital volume. Logistic regression was used to estimate expected FTR rates based on patient factors for each major complication. Results The overall unadjusted in-hospital mortality was 6.96%. Risk-adjusted in-hospital mortality rates varied 3.1-fold across terciles (low 3.3%, high 10.3%; p-trend 30/year: 40.1%; p-trend 30/year 17.9%; p=0.03) Conclusions Failure to rescue may serve as an important quality metric for durable LVAD implant procedures, and identifying strategies for successful rescue after complications may reduce hospital variations in mortality.