Failure to rescue as a quality metric in congenital heart surgeries in a high- complexity service provider institution located in a middle-income country

Abstract

Abstract Background Failure to rescue has been an effective quality metric in congenital heart surgery. Conversely, morbidity and mortality depend greatly on non-modifiable individual factors and have a weak correlation with better-quality performance. We aim to measure the complications, mortality, and risk factors in pediatric patients undergoing congenital heart surgery in a high-complexity institution located in a low-income country and compare it with other institutions that have conducted a similar study.Methods A retrospective observational study was conducted in a high-complexity service provider institution, in Cali, Colombia. All pediatric patients undergoing any congenital heart surgery between 2019 and 2022 were included. The main outcomes evaluated in the study were complication, mortality, and failure to rescue rate. Univariate and multivariate logistic regression analysis was performed with mortality as the outcome variable.Results We evaluated 308 congenital heart surgeries. Regarding the outcomes, 201 (65%) complications occurred, 23 (7.5%) patients died, and the FTR of the entire cohort was 11.4%. The presence of a postoperative complication (OR 14.88, CI 3.06-268.37, p = 0.009), age (OR 0.79, CI 0.57–0.96, p = 0.068), and urgent/emergent surgery (OR 8.14, CI 2.97–28.66, p < 0.001) were the most significant variables in predicting mortality.Conclusions Failure to rescue is an effective and comparable quality measure in healthcare institutions and is the major contributor to postoperative mortality in congenital heart surgeries. Despite our higher mortality and complication rate, we obtained a comparable failure to rescue rate to high-income countries' health institutions.