Failure to rescue in frail surgical patients

GEMSSTAR R03摘要 脆弱性是指储备减少和功能衰退，随之而来的脆弱性和贫乏 从压力源中恢复的结果通常发生在老年患者。尽管虚弱与年龄不同，但它的高度 随着美国人口老龄化，虚弱的流行程度可能会增加。日益增长的流行率 老年患者人数的增加和虚弱将对外科服务提出更大的要求。三分之一的患者 65-85岁的老人将在生命的最后一年内接受一次大手术。提供最好的质量 护理，医疗保健提供者和医院必须制定战略，以满足这些不断增长的需求 并确保为老年外科病人提供更高质量的护理。最近的数据表明，这种脆弱性 是不同外科人群围手术期死亡率、发病率和费用增加的有力预测因子。 抢救失败(FTR)指的是在住院期间未能防止因可治疗的并发症而死亡 (例如，手术后大出血)，并被用来衡量医院质量。 我们的研究旨在表明，脆弱会独立于其他医院因素影响救援失败。我们也 认为某些医院在抢救虚弱患者方面做得更好，我们的目标是确定这些医院的特点 医院。尽管这种联系是直观的，但到目前为止还没有人研究过这种联系。这将是第一个要检查的研究 虚弱主要是患者的特征，FTR是一种质量指标，据信 需要住院治疗。该提案还包括一项详细的专业发展计划和培训，将 对于成功完成这项研究以及对Arya博士的职业发展和 向老龄化和外科质量研究过渡。这项研究的重大发现将改变失败的方式 抢救研究是用于医院质量的，将为开发新的干预措施奠定基础 或对患者和医院水平的方案，以改善虚弱患者的手术结果。

GEMSSTAR R03 Abstract Frailty is the occurrence of decreased reserve and functional decline with resultant vulnerability and poor outcomes in recovery from a stressor usually in older patients. Although frailty is distinct from age, it is highly correlated, and as the US population ages, the prevalence of frailty will likely increase. The growing prevalence of older patient population and frailty will place greater demands on surgical services. One third of all patients aged 65-85 will undergo a major surgical procedure within the last year of life. To provide the best quality of care, it is imperative that healthcare providers and hospitals develop strategies to meet these growing demands and to ensure higher-quality care for geriatric surgical patients. Recent data demonstrate that frailty is a powerful predictor of increased perioperative mortality, morbidity and cost in various surgical populations. Failure to rescue (FTR) refers to a failure to prevent death from treatable complications during hospitalization (e.g. major hemorrhage after surgery) and is used a metric for hospital quality. Our study aims to show that frailty impacts failure to rescue independent of other hospital factors. We also think that certain hospitals are better at rescuing frail patients and we aim to identify characteristics of such hospitals. Although intuitive, this association has not been studied so far. This will be the first study to examine the interplay of frailty, which is primarily a patient characteristic, and FTR- a quality indicator believed to hospital dependent. The proposal also entails a detailed professional development plan with training that will be essential both for successful completion of this research and toward Dr. Arya's career development and transition to aging and surgical quality research. Significant findings from this study will change the way failure to rescue research is used for hospital quality and will lay the groundwork for development of new interventions or protocols on a patient as well as hospital level to improve surgical outcomes in frail patients.