Failure to Rescue After Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis (2012-2020)

Area of Science:

• Neurosurgery
• Surgical Outcomes
• Patient Safety

Background:

• Failure to rescue (FTR) is defined as mortality within 30 days post-major complication.
• Existing studies report varied FTR rates, influenced by patient factors and complication incidence.
• The impact of frailty on FTR after brain tumor resection (BTR) remains underexplored.

Purpose of the Study:

• To identify patient characteristics and postoperative complications predicting FTR in BTR patients.
• To assess the association between frailty and FTR in the BTR cohort.
• To develop a predictive model for FTR in BTR.

Main Methods:

• Utilized the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020).
• Included patients who underwent BTR identified by craniotomy codes.
• Measured frailty using the Risk Analysis Index.

Main Results:

• Analyzed 31,667 BTR patients; 7.71% experienced major complications, and 15.8% faced FTR.
• Multivariate analysis identified transfer status and nonelective surgery as independent FTR predictors.
• Frail and severely frail patients had significantly higher odds of FTR (OR 4.03 and 7.90, respectively).
• Cardiac arrest (OR 12.75), unplanned reintubation (OR 2.46), and septic shock (OR 2.02) predicted FTR.
• The predictive model showed excellent discriminatory accuracy (c-statistic: 0.81).

Conclusions:

• Preoperative frailty and specific postoperative complications (e.g., cardiac arrest) predict FTR in BTR patients.
• Identifying frail patients preoperatively can guide interventions to optimize surgical readiness.
• This knowledge can improve patient selection and perioperative management for BTR.