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Objective:

To determine whether a hospital's ability to rescue patients from major complications underlies variation in outcomes for elderly patients undergoing emergent surgery.

Background:

Perioperative mortality rates in elderly patients undergoing emergent general/vascular operations are high and vary widely across Michigan hospitals.

Methods:

We identified 23,224 patients undergoing emergent general/vascular surgical procedures at 41 hospitals within the Michigan Surgical Quality Collaborative between 2006 and 2011. Hospitals were ranked by risk-and reliability-adjusted 30-day mortality rates and grouped into tertiles. We stratified patients by age (< 75 and≥ 75 years). Risk-adjusted major complication and failure-to-rescue (ie, mortality after major complication) rates were determined for each tertile of hospital mortality.

Results:

Risk-adjusted mortality rates in elderly patients varied 2-fold across all …