Incidence of failure-to-rescue after coronary artery bypass grafting: a multicenter observational study from the REPLICCAR II registry in Brazil

Background: Failure-to-rescue refers to the rate of failure amongst healthcare teams in reversing complications that occur during a patient’s hospitalization. This study aimed to investigate the failure-to-rescue rate following coronary artery bypass grafting (CABG). Methods: Cross-sectional cohort study of the multicenter database “Registro Paulista de Cirurgia Cardiovascular II” (REPLICCAR II), which includes data from nine reference centers for cardiac surgery in São Paulo State. The study population included patients > 18 years of age who had undergone primary and isolated CABG surgery between 2017 and 2019 in Brazil. The outcome measured was failure-to-rescue (including death and the development of postoperative complications: prolonged ventilation time, stroke, reoperation, and kidney injury). The study used the Society of Thoracic Surgeons (STS) risk score to calculate the expected complication rates. Results: Out of the 3964 patients, 439 developed one or more of the analyzed complications, and out of those, 94 died (2.37% of the full sample). The standardized mortality ratio (SMR) for patients who developed one complication was 8.84% (10.7%/1.21%), whereas those with two combinations of complications had an SMR of 32.34% (53.68%/1.66%) and three complications had an SMR of 42.02% (50%/1.19%). However, patients who progressed without the analyzed complications had an SMR of 0.95% (0.74%/0.80%). Conclusion: The REPLICCAR II database revealed a failure-to-rescue rate of 21.41% (94/439), and the SMR increased progressively according to the greater number of complications. Our findings emphasize the need to measure the impact of early diagnosis and effective hospital team response by parameterizing the risk of expected death after severe complications. Trial registration: The REPLICCAR Registry and The Statewide Quality Improvement Initiative, ID NCT05363696.