The impact of preexisting comorbidities on failure to rescue outcomes in nonelderly trauma patients.

Background: Death after complication or "failure to rescue" (FTR) contributes to differences in risk-adjusted mortality rates among trauma centers and is considered an indicator of quality of care. Successful management of trauma patients requires not only appropriately responding to complications but also timely recognition of adverse events. Identifying associations between patient characteristics, such as the presence of comorbidities, and FTR outcomes can potentially improve early detection of complications and can reduce the risk of in-hospital mortality.

Methods: We performed a retrospective cohort study that analyzed patient records included in the National Trauma Data Bank from years 2008 to 2010. Cox regression modeling was used to determine the contribution of individual comorbidities to FTR outcomes while controlling for confounding variables.

Results: Diabetes, congestive heart failure, history of myocardial infarction, and dialysis were associated with greater hazard ratios (HRs) (95% confidence interval [CI]) for FTR (1.19 [1.05-1.35], 1.63 [1.30-2.05], 1.40 [1.08-1.81], 2.34 [1.72-3.19], respectively). Smoking, alcoholism, and respiratory disease were associated with a lower risk of FTR (HR [95% CI], 0.68 [0.60-0.77]; 0.88 [0.80-0.98]; and 0.77 [0.66-0.91], respectively). Obesity and hypertension were not associated with increased risk of FTR.

Conclusion: Preexisting comorbidities contributed significantly to risk of death after complication in the trauma population. Identifying processes of care that lead to better management of complications in patients with comorbidities would improve trauma centers' overall mortality outcomes.

Level Of Evidence: Prognostic study, level IV.