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Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries : a 7-day cohort study of elective surgery

T. Ahmad, R. A. Bouwman, I. Grigoras, C. Aldecoa, C. Hofer, A. Hoeft, P. Holt, L. A. Fleisher, W. Buhre, R. M. Pearse, et al. (2017) BRITISH JOURNAL OF ANAESTHESIA. 119(2). p.258-266
abstract
Background. The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems. Methods. We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest). Results. A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17%) developed one or more postoperative complication, with 207 deaths in hospital (0.5%), giving an overall failure-to-rescue rate of 2.8%. When hospitals were ranked in quintiles by procedural volume, we identified a threefold variation in mortality (Q1: 0.6% vs Q5: 0.2%) and a two-fold variation in failure-to-rescue (Q1: 3.6% vs Q5: 1.7%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failureto- rescue, indicating differences between hospitals in the risk of death among patients after they develop complications. Conclusions. Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.
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author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
HIGH-RISK SURGERY, HOSPITAL MORTALITY, SURGICAL MORTALITY, PATIENT, MORTALITY, CANCER-SURGERY, GLOBAL HEALTH, COMPLICATIONS, OUTCOMES, QUALITY, VOLUME, postoperative care, methods, postoperative care, statistics and, numerical data, surgical procedures, operative, mortality, postoperative, care, methods
journal title
BRITISH JOURNAL OF ANAESTHESIA
Br. J. Anaesth.
volume
119
issue
2
pages
9 pages
publisher
Oxford Univ Press
place of publication
Oxford
Web of Science type
Article
Web of Science id
000406549900063
ISSN
0007-0912
1471-6771
DOI
10.1093/bja/aex185
language
English
UGent publication?
yes
classification
A1
copyright statement
I don't know the status of the copyright for this publication
id
8557688
handle
http://hdl.handle.net/1854/LU-8557688
date created
2018-03-28 12:46:35
date last changed
2018-05-17 13:13:23
@article{8557688,
  abstract     = {Background. The incidence and impact of postoperative complications are poorly described. Failure-to-rescue, the rate of death following complications, is an important quality measure for perioperative care but has not been investigated across multiple health care systems. Methods. We analysed data collected during the International Surgical Outcomes Study, an international 7-day cohort study of adults undergoing elective inpatient surgery. Hospitals were ranked by quintiles according to surgical procedural volume (Q1 lowest to Q5 highest). For each quintile we assessed in-hospital complications rates, mortality, and failure-to-rescue. We repeated this analysis ranking hospitals by risk-adjusted complication rates (Q1 lowest to Q5 highest). Results. A total of 44 814 patients from 474 hospitals in 27 low-, middle-, and high-income countries were available for analysis. Of these, 7508 (17\%) developed one or more postoperative complication, with 207 deaths in hospital (0.5\%), giving an overall failure-to-rescue rate of 2.8\%. When hospitals were ranked in quintiles by procedural volume, we identified a threefold variation in mortality (Q1: 0.6\% vs Q5: 0.2\%) and a two-fold variation in failure-to-rescue (Q1: 3.6\% vs Q5: 1.7\%). Ranking hospitals in quintiles by risk-adjusted complication rate further confirmed the presence of important variations in failureto- rescue, indicating differences between hospitals in the risk of death among patients after they develop complications. Conclusions. Comparison of failure-to-rescue rates across health care systems suggests the presence of preventable postoperative deaths. Using such metrics, developing nations could benefit from a data-driven approach to quality improvement, which has proved effective in high-income countries.},
  author       = {Ahmad, T. and Bouwman, R. A. and Grigoras, I. and Aldecoa, C. and Hofer, C. and Hoeft, A. and Holt, P. and Fleisher, L. A. and Buhre, W. and Pearse, R. M. and Ferguson, Marissa and MacMahon, Michael and Shulman, Mark and Cherian, Ritchie and Currow, Helen and Kanathiban, Kathirgamanathan and Gillespie, David and Pathmanathan, Edward and Phillips, Katherine and Reynolds, Jenifer and Rowley, Joanne and Douglas, Jeanene and Kerridge, Ross and Garg, Sameer and Bennett, Michael and Jain, Megha and Alcock, David and Terblanche, Nico and Cotter, Rochelle and Leslie, Kate and Stewart, Marcelle and Zingerle, Nicolette and Clyde, Antony and Hambidge, Oliver and Rehak, Adam and Cotterell, Sharon and Huynh, Wilson Binh Quan and McCulloch, Timothy and Ben-Menachem, Erez and Egan, Thomas and Cope, Jennifer and Halliwell, Richard and Fellinger, Paul and Haisjackl, Markus and Haselberger, Simone and Holaubek, Caroline and Lichtenegger, Paul and Scherz, Florian and Schmid, Werner and Hoffer, Franz and Cakova, Veronika and Eichwalder, Andreas and Fischbach, Norbert and Klug, Reinhold and Schneider, Elisabeth and Vesely, Martin and Wickenhauser, Reinhart and Grubmueller, Karl Gernot and Leitgeb, Marion and Lang, Friedrich and Toro, Nancy and Bauer, Marlene and Laengle, Friedrich and Haberl, Claudia and Mayrhofer, Thomas and Trybus, Christoph and Buerkle, Christian and Forstner, Karin and Germann, Reinhard and Rinoesl, Harald and Schindler, Elke and Trampitsch, Ernst and Bogner, Gerhard and Dankl, Daniel and Duenser, Martin and Fritsch, Gerhard and Gradwohl-Matis, Ilse and Hartmann, Andreas and Hoelzenbein, Thomas and Jaeger, Tarkan and Landauer, Franz and Lindl, Gregor and Lux, Michael and Steindl, Johannes and Stundner, Ottokar and Szabo, Christian and Bidgoli, Jawad and Verdoodt, Hans and Forget, Patrice and Kahn, David and Lois, Fernande and Momeni, Mona and Pregardien, Caroline and Pospiech, Audrey and Steyaert, Arnaud and Veevaete, Laurent and De Kegel, Dirk and De Jongh, Karen and Foubert, Luc and Smitz, Carine and Vercauteren, Marcel and Poelaert, Jan and Van Mossevelde, Veerle and Abeloos, Jacques and Bouchez, Stefaan and Coppens, Marc and De Baerdemaeker, Luc and Deblaere, Isabel and De Bruyne, Ann and De Hert, Stefan and Fonck, Kristine and Heyse, Bjorn and Jacobs, Tom and Lapage, Koen and Moerman, Anneliese and Neckebroek, Martine and Parashchanka, Aliaksandra and Roels, Nathalie and Van Den Eynde, Nancy and Vandenheuvel, Micha{\"e}l and Van Limmen, Jurgen and Vanluchene, Ann and Vanpeteghem, Caroline and Wouters, Patrick and WYFFELS, PIET and Huygens, Christel and Vandenbempt, Punitha and Van de Velde, Marc and Dylst, Dimitri and Janssen, Bruno and Schreurs, Evelien and Aleixo, Fabia Berganton and Candido, Keulle and Batista, Hugo Dias and Guimaraes, Mario and Guizeline, Jaqueline and Hoffmann, Joao and Lobo, Suzana and Marques Lobo, Francisco Ricardo and Nascimento, Vinicius and Nishiyama, Katia and Pazetto, Lucas and Souza, Daniela and Rodrigues, Rodrigo Souza and Vilela dos Santos, Ana Maria and Jardim, Jaquelline and Sa Malbouisson, Luiz Marcelo and Silva, Joao and do Nascimento Junior, Paulo and Baio, Thalissa Herminia and Pereira de Castro, Gabriel Isaac and Watanabe Oliveira, Henri Roger and Amendola, Cristina Prata and Cardoso, Gutemberg and Ortega, Daniela and Brotto, Ana Flavia and De Oliveira, Mirella Cristine and Rea-Neto, Alvaro and Dias, Fernando and Travi, Maria Eduarda and Zerman, Luiza and Azambuja, Pedro and Knibel, Marcos Freitas and Martins, Antonio and Almeida, William and Neder Neto, Calim and Tardelli, Maria Angela and Caser, Eliana and Machado, Marcio and Aguzzoli, Crisitiano and Baldisserotto, Sergio and Tabajara, Fernanda Beck and Bettega, Fernanda and Rodrigues Junior, La Hore Correa and de Gasperi, Julia and Faina, Lais and Nolasco, Marcos Farias and da Costa Fischer, Bruna Ferreira and de Campos Ferreira, Mariana Fosch and Hartmann, Cristina and Kliemann, Marta and Ribeiro, Gustavo Luis Hubert and Fraga, Julia Merladete and Netto, Thiago Motta and Pozza, Laura Valduga and Wendling, Paulo Rafael and Azevedo, Caroline and Garcia, Juliana and Lopes, Marcel and Maia, Bernardo and Maselli, Paula and Melo, Ralph and Mendes, Weslley and Neves, Matheus and Ney, Jacqueline and Piras, Claudio and Applewhaite, Christopher and Carr, Adrienne and Chow, Lorraine and Duttchen, Kaylene and Foglia, Julena and Greene, Michael and Hinther, Ashley and Houston, Kendra and McCormick, Thomas Jared and Mikhayel, Jennifer and Montasser, Sam and Ragan, Alex and Suen, Andrew and Woolsey, Adrianna and Yu, Hai Chuan and Funk, Duane and Kowalski, Stephen and Legaspi, Regina and McDonald, Heather and Siddiqui, Faisal and Pridham, Jeremy and Rowe, Bernadette and Sampson, Sonia and Thiessen, Barton and Zbitnew, Geoff and Bernard, Andre and George, Ronald and Jones, Philip and Moor, Rita and Siddiqui, Naveed and Wolfer, Alexandra and Tran, Diem and Winch, Denyse and Dobson, Gary and McCormick, Thomas and Montasser, Osama and Hall, Richard and Baghirzada, Leyla and Curley, Gerard and Dai, Si Yuan and Hare, Gregory and Lee, Esther and Shastri, Uma and Tsui, Albert and Yagnik, Anmol and Alvares, Danielle and Choi, Stephen and Dwyer, Heather and Flores, Kathrina and McCartney, Colin and Somascanthan, Priya and Beattie, Scott and Carroll, Jo and Pazmino-Canizares, Janneth and Wijeysundera, Duminda and Ami, Noam and Chan, Vincent and Perlas, Anahi and Argue, Ruth and Huang, Yang and Lavis, Katie and Mayson, Kelly and Cao, Ying and Gao, Hong and Hu, Tingju and Lv, Jie and Yang, Jian and Yang, Yang and Zhong, Yi and Zhou, Jing and Zou, Xiaohua and He, Miao and Li, Xiaoying and Luo, Dihuan and Wang, Haiying and Yu, Tian and Chen, Liyong and Wang, Lijun and Cai, Yunfei and Cao, Zhongming and Li, Yanling and Lian, Jiaxin and Sun, Haiyun and Wang, Sheng and Wang, Zhipeng and Wang, Kenru and Zhu, Yi and Du, Xindan and Fan, Hao and Fu, Yunbin and Huang, Lixia and Huang, Yanming and Hwan, Haifang and Luo, Hong and Qu, Pi-Sheng and Tao, Fan and Wang, Zhen and Wang, Guoxiang and Wang, Shun and Zhang, Yan and Zhang, Xiaolin and Chen, Chao and Wang, Weixing and Liu, Zhengyuan and Fan, Lihua and Tang, Jing and Chen, Yijun and Chen, Yongjie and Han, Yangyang and Huang, Changshun and Liang, Guojin and Shen, Jing and Wang, Jun and Yang, Qiuhong and Zhen, Jungang and Zhou, Haidong and Chen, Junping and Chen, Zhang and Li, Xiaoyu and Meng, Bo and Ye, Haiwang and Zhang, Xiaoyan and Bi, Yanbing and Cao, Jianqiao and Guo, Fengying and Lin, Hong and Liu, Yang and Lv, Meng and Shi, Pengcai and Song, Xiumei and Sun, Chuanyu and Sun, Yongtao and Wang, Yuelan and Wang, Shenhui and Zhang, Min and Chen, Rong and Hou, Jiabao and Leng, Yan and Meng, Qing-tao and Qian, Li and Shen, Zi-ying and Xia, Zhong-yuan and Xue, Rui and Zhang, Yuan and Zhao, Bo and Zhou, Xian-jin and Chen, Qiang and Guo, Huinan and Guo, Yongqing and Qi, Yuehong and Wang, Zhi and Wei, Jianfeng and Zhang, Weiwei and Zheng, Lina and Bao, Qi and Chen, Yaqiu and Chen, Yijiao and Fei, Yue and Hu, Nianqiang and Hu, Xuming and Lei, Min and Li, Xiaoqin and Lv, Xiaocui and Lv, Jie and 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Luo, Foquan and Ma, Longxian and Min, Jia and Shi, Xiaoyun and Song, Zhiping and Wan, Xianwen and Xiong, Yingfen and Xu, Lin and Yang, Shuangjia and Zhang, Qin and Zhang, Hongyan and Zhang, Huaigen and Zhang, Xuekang and Zhao, Lili and Zhao, Weihong and Zhao, Weilu and Zhu, Xiaoping and Bai, Yun and Chen, Linbi and Chen, Sijia and Dai, Qinxue and Geng, Wujun and Han, Kunyuan and He, Xin and Huang, Luping and Ji, Binbin and Jia, Danyun and Jin, Shenhui and Li, Qianjun and Liang, Dongdong and Luo, Shan and Lwang, Lulu and Mo, Yunchang and Pan, Yuanyuan and Qi, Xinyu and Qian, Meizi and Qin, Jinling and Ren, Yelong and Shi, Yiyi and Wang, Junlu and Wang, Junkai and Wang, Leilei and Xie, Junjie and Yan, Yixiu and Yao, Yurui and Zhang, Mingxiao and Zhao, Jiashi and Zhuang, Xiuxiu and Ai, Yanqiu and Du, Fang and He, Long and Huang, Ledan and Li, Zhisong and Li, Huijuan and Li, Yetong and Li, Liwei and Meng, Su and Yuan, Yazhuo and Zhang, Enman and Zhang, Jie and Zhao, Shuna and Ji, Zhenrong and Pei, Ling and Wang, Li and Chen, Chen and Dong, Beibei and Li, Jing and Miao, Ziqiang and Mu, Hongying and Qin, Chao and Su, Lin and Wen, Zhiting and Xie, Keliang and Yu, Yonghao and Yuan, Fang and Hu, Xianwen and Zhang, Ye and Xiao, Wangpin and Zhu, Zhipeng and Dai, Qingqing and Fu, Kaiwen and Hu, Rong and Hu, Xiaolan and Huang, Song and Li, Yaqi and Liang, Yingping and Yu, Shuchun and Guo, Zheng and Jing, Yan and Tang, Na and Wu, Jie and Yuan, Dajiang and Zhang, Ruilin and Zhao, Xiaoying and Li, Yuhong and Bai, Hui-Ping and Liu, Chun-Xiao and Liu, Fei-Fei and Ren, Wei and Wang, Xiu-Li and Xu, Guan-Jie and Hu, Na and Li, Bo and Ou, Yangwen and Tang, Yongzhong and Yao, Shanglong and Zhang, Shihai and Kong, Cui-Cui and Liu, Bei and Wang, Tianlong and Xiao, Wei and Lu, Bo and Xia, Yanfei and Zhou, Jiali and Cai, Fang and Chen, Pushan and Hu, Shuangfei and Wang, Hongfa and Wu, Jie and Xu, Qiong and Hu, Liu and Jing, Liang and Li, Jing and Li, Bin and Liu, Qiang and Liu, Yuejiang and 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Ling and Ma, Shu Kai and Kaushik, Shuchi and Shah, Bhagyesh and Shah, Dhiren and Shah, Sanjay and Ar, Praburaj and Muthuchellappan, Radhakrishnan and Agarwal, Vandana and Divatia, Jigeeshu and Kulkarni, Atul and Mishra, Sanghamitra and Nimje, Ganesh and Pande, Swati and Savarkar, Sukhada and Shrivastava, Aditi and Thomas, Martin and Yegnaram, Shashikant and Hidayatullah, Rahmat and Chandra, Susilo and Tantri, Aida and Puar, Nasman and Niman, Sumara and Indra, Imai and Hamzah, Zulkarnain and Yuliana, Annika and Abidin, Ucu Nurhadiat and Dursin, Ade Nurkacan and Kurnia, Andri and Susanti, Ade and Handayani, Dini and Alit, Mahaalit Aribawa and Arya, Aryabiantara and Senapathi, Tjokorda Gde Agung and Utara, Utara Hartawan and Wid, Widnyana Made and Wima, Semarawima and Wir, Wiryana Made and Jehosua, Brillyan and Kaunang, Jonathan and Lantang, Eka Yudha and Najoan, Rini and Waworuntu, Neil and Awad, Hadi and Fuad, Akram and Geddoa, Emad and Geddoa, Burair and Khalaf, Abdel Razzaq and Al hussaini, Sabah and Albaj, Safauldeensalem and Kenber, Maithem and Bettinelli, Alessandra and Spadaro, Savino and Volta, Carlo Alberto and Giancarlo, Luigi and Sottosanti, Vicari and Copetti, Elisa and Della Rocca, Giorgio and Spagnesi, Lorenzo and Toretti, Ilaria and Alloj, Chiara and Cardellino, Silvano and Carmino, Livio and Costanzo, Eleonora and Fanfani, Lucia Caterina and Novelli, Maria Teresa and Roasio, Agostino and Bellandi, Mattia and Beretta, Luigi and Bignami, Elena and Bocchino, Speranza and Cabrini, Luca and Corti, Daniele and Landoni, Giovanni and Meroni, Roberta and Moizo, Elena and Monti, Giacomo and Pintaudi, Margherita and Plumari, Valentina Paola and Taddeo, Daiana and Testa, Valentina and Winterton, Dario and Zangrillo, Alberto and Cloro, Luigi Maria and Colangelo, Chiara and Colangelo, Antonio and Rotunno, Giuseppe and Paludi, Miguel Angel and Maria, Cloro Paolo and Pata, Antonio and Parrini, Vieri and Gatta, Alessandro and Nastasi, Mauro and Tinti, Carla and Baroselli, Antonio and Spagnesi, Lorenzo and Arrigo, Mario and Benevento, Angelo and Bottini, Corrado and Cannavo, Maurizio and Gastaldi, Christian and Marchesi, Alessandro and Pascazio, Angelantonio and Pata, Francesco and Pozzi, Emilio and Premoli, Alberto and Tessera, Gaetano and Boschi, Luca and D'Andrea, Rocco and Ghignone, Federico and Poggioli, Gilberto and Sibilio, Andrea and Taffurelli, Mario and Ugolini, Giampaolo and Ab Majid, Mohd Azuan and Ab Rahman, Rusnah and Joseph, James and Pathan, Furquan and Shah, Mohammad Hafizshah Sybil and Yap, Huey Ling and Cheah, Seleen and Chin, Im Im and Looi, Ji Keon and Tan, Siew Ching and Visvalingam, Sheshendrasurian and Kwok, Fan Yin and Lee, Chew Kiok and Tan, Tse Siang and Wong, Sze Meng and Abdullah, Noor Hairiza and Liew, Chiat Fong and Luxuman, Lovenia and Zin, Nor Hafizah Mohd and Norddin, Muhamad Faiz and Alias, Raja Liza Raja and Wong, Juan Yong and Yong, Johnny and Bin Mustapha, Mohd Tarmimi and Chan, Weng Ken and Dzulkipli, Norizawati and Kuan, Pei Xuan and Lee, Yew Ching and Alias, Anita and Guok, Eng Ching and Jee, Chiun Chen and Ramon, Brian Rhadamantyne and Wong, Cheng Weng and Ghafar, Fara Nur Idayu Abd and Aziz, Faizal Zuhri and Hussain, Nabilah and Lee, Hooi Sean and Sukawi, Ismawaty and Woon, Yuan Liang and Hadi, Husni Zaeem Abd and Azam, Ummi Azmira Ahmad and Alias, Abdul Hafiz and Kesut, Saiful Aizar and Lee, Jun May and Ooi, Dar Vin and Sulaiman, Hetty Ayuni and Lih, Tengku Alini Tengku and Mansor, Marzida and Veerakumaran, Jeyaganesh and Luna, Pastor and Rojas, Eder and Resendiz, Gerardo Esteban Alvarez and Zapata, Darcy Danitza Mari and Lopez, Julio Cesar Jesus Aguilar and Flores, Armando Adolfo Alvarez and Amador, Juan Carlos Bravo and Avila, Erendira Jocelin Dominguez and Aquino, Laura Patricia Gonzalez and Rodriguez, Ricardo Lopez and Landa, Mariana Torres and Urias, Emma and Hollmann, Markus and Hulst, Abraham and Preckel, Osne Kirzner Benedikt and Koopman-van Gemert, Ankie and Bouwman, Arthur and Buise, Marc and Tolenaar, Noortje and Weber, Eric and de Fretes, Jennifer and Houweling, Peter and Ormskerk, Patricia and Van Bommel, Jasper and Buhre, Wolfgang and Lance, Marcus and Smit-Fun, Valerie and van Zundert, Tom and Baas, Peter and de Boer, Hans Donald and Sprakel, Joost and Elferink-Vonk, Renske and Noordzij, Peter and van Zeggeren, Laura and Brand, Bastiaan and Spanjersberg, Rob and ten Bokkel-Andela, Janneke and Numan, Sandra and van Klei, Wilton and van Zaane, Bas and Boer, Christa and van Duivenvoorde, Yoni and Hering, Jens Peter and van Rossum, Sylvia and Zonneveldt, Harry and Campbell, Doug and Hoare, Siobhan and Santa, Sahayam and Ali, Marlynn and Allen, Sara Jane and Beavis, Vanessa and Bell, Rachel and Campbell, Douglas and Choi, Hyun-min David and Drake, Matthew and Farrell, Helen and Hayes, Katia and Higgie, Kushlin and Holmes, Kerry and Jenkins, Nicole and Kim, Chang Joon and Kim, Steven and Law, Kiew Chai and McAllister, Davina and Park, Karen and Pedersen, Karen and Pfeifer, Leesa and Pozaroszczyk, Anna and Salmond, Timothy and Steynor, Martin and Tan, Michael and Short, Tim and Waymouth, Ellen and Ab Rahman, Ahmad Sufian and Armstrong, John and Dudson, Rosie and Jenkins, Nia and Nilakant, Jayashree and Richard, Seigne and Virdi, Pardeep and Dixon, Liane and Donohue, Roana and Farrow, Mehreen and Kennedy, Ross and Marissa, Henderson and McKellow, Margie and Nicola, Delany and Pascoe, Rebecca and Roberts, Stephen John and Rowell, George and Sumner, Matthew and Templer, Paul and Chandrasekharan, Shardha and Fulton, Graham and Jammer, Ib and Ali, Marlynn and More, Richard and Wilson, Leona and Chang, Yuan Hsuan and Foley, Julia and Fowler, Carolyn and Panckhurst, Jonathan and Sara, Rachel and Stapelberg, Francois and Campbell, Doug and Cherrett, Veronica and Ganter, Donna Louise and McAllister, Davina and McCann, Lloyd and Foley, Julia and Gilmour, Fiona and Lumsden, Rachelle and Moores, Mark and Olliff, Sue and Sardareva, Elitza and Stapelberg, Francois and Tai, Joyce and Wikner, Matthew and Wong, Christopher and Chaddock, Mark and Czepanski, Carolyn and McKendry, Patrick and Polakovic, Daniel and Polakovich, Daniel and Robert, Axe and Belda, Margarita Tormo and Norton, Tracy and Stapelberg, Francois and Alherz, Fadhel and Barneto, Lisa and Ramirez, Alberto and Sayeed, Ahmed and Smith, Nicola and Bennett, Cambell and McQuoid, Shane and Bell, Rachel and Jansen, Tracy-Lee and Nico, Zin and Scott, John and Freschini, David and Freschini, Angela and Hopkins, Brian and Manson, Lara and Stoltz, Deon and Bates, Alexander and Davis, Simon and Freeman, Victoria and McGaughran, Lynette and Williams, Maya and Sharma, Swarna Baskar and Burrows, Tom and Byrne, Kelly and English, Duane and Johnson, Robert and Law, Kiew Chai and Manikkam, Brendon and McAllister, Davina and Naidoo, Shaun and Rumball, Margot and Whittle, Nicola and Franks, Romilla and Gibson-Lapsley, Hannah and McAllister, Davina and Salter, Ryan and Walsh, Dean and Cooper, Richard and Perry, Katherine},
  issn         = {0007-0912},
  journal      = {BRITISH JOURNAL OF ANAESTHESIA},
  keyword      = {HIGH-RISK SURGERY,HOSPITAL MORTALITY,SURGICAL MORTALITY,PATIENT,MORTALITY,CANCER-SURGERY,GLOBAL HEALTH,COMPLICATIONS,OUTCOMES,QUALITY,VOLUME,postoperative care,methods,postoperative care,statistics and,numerical data,surgical procedures,operative,mortality,postoperative,care,methods},
  language     = {eng},
  number       = {2},
  pages        = {258--266},
  publisher    = {Oxford Univ Press},
  title        = {Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries : a 7-day cohort study of elective surgery},
  url          = {http://dx.doi.org/10.1093/bja/aex185},
  volume       = {119},
  year         = {2017},
}

Chicago
Ahmad, T., R. A. Bouwman, I. Grigoras, C. Aldecoa, C. Hofer, A. Hoeft, P. Holt, et al. 2017. “Use of Failure-to-rescue to Identify International Variation in Postoperative Care in Low-, Middle- and High-income Countries : a 7-day Cohort Study of Elective Surgery.” British Journal of Anaesthesia 119 (2): 258–266.
APA
Ahmad, T., Bouwman, R. A., Grigoras, I., Aldecoa, C., Hofer, C., Hoeft, A., Holt, P., et al. (2017). Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries : a 7-day cohort study of elective surgery. BRITISH JOURNAL OF ANAESTHESIA, 119(2), 258–266.
Vancouver
1.
Ahmad T, Bouwman RA, Grigoras I, Aldecoa C, Hofer C, Hoeft A, et al. Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries : a 7-day cohort study of elective surgery. BRITISH JOURNAL OF ANAESTHESIA. Oxford: Oxford Univ Press; 2017;119(2):258–66.
MLA
Ahmad, T., R. A. Bouwman, I. Grigoras, et al. “Use of Failure-to-rescue to Identify International Variation in Postoperative Care in Low-, Middle- and High-income Countries : a 7-day Cohort Study of Elective Surgery.” BRITISH JOURNAL OF ANAESTHESIA 119.2 (2017): 258–266. Print.