Failure to Rescue in Major Abdominal Surgery: A Regional Australian Experience

Area of Science:

• Surgical Quality and Patient Safety
• Critical Care Medicine
• Health Services Research

Background:

• Failure to rescue (FTR) is a key indicator of healthcare quality, reflecting the ability to manage patient deterioration.
• This study investigates the link between pre-operative patient factors and FTR following major abdominal surgery.

Purpose of the Study:

• To identify pre-operative risk factors associated with failure to rescue (FTR) in patients undergoing major abdominal surgery.
• To inform clinical decision-making and patient management strategies.

Main Methods:

• Retrospective chart review of patients undergoing major abdominal surgery with Clavien-Dindo (CDC) III-V complications (2012-2019).
• Comparison of pre-operative demographics, comorbidities (Charlson Comorbidity Index - CCI), American Society of Anaesthesiology (ASA) Score, and biochemistry between survivors and non-survivors.
• Logistic regression analysis to determine odds ratios (ORs) and 95% confidence intervals (CIs).

Main Results:

• Of 2579 patients, 374 (14.5%) had CDC III-V complications, with 88 (23.5% FTR) dying.
• Pre-operative risk factors for FTR included ASA score ≥3, CCI ≥3, and serum albumin <35 g/L.
• Operative factors like emergency surgery, cancer surgery, significant blood loss, and ICU admission increased FTR risk. End-organ failure predicted mortality.

Conclusions:

• Pre-operative risk stratification for FTR is crucial for major abdominal surgery.
• Identifying high-risk patients can guide pre-operative optimization or surgical candidacy decisions.
• This approach supports shared decision-making and enhances patient safety.