Nationwide Analysis of Failure to Rescue After Liver Transplantation

Area of Science:

• Hepatology
• Transplantation Surgery
• Health Services Research

Background:

• Failure to rescue (FTR) is defined as mortality following a major complication.
• Liver transplantation (LT) centers may benefit from using FTR as a quality metric.
• Nationwide data on FTR rates and outcomes after LT are limited.

Purpose of the Study:

• To determine the nationwide rate of FTR after LT.
• To investigate the impact of FTR on patient outcomes.
• To identify predictors of FTR in LT recipients.

Main Methods:

• Analysis of the 2015-2017 Nationwide Readmissions Database for LT patients.
• Stratification of centers into low, intermediate, and high average mortality groups.
• Identification of postoperative complications and application of multivariable regression analysis to determine FTR predictors.

Main Results:

• The overall FTR rate was 5%, with significant variations across centers (high-mortality centers: 8.8%; low-mortality centers: 1.3%).
• Common complications leading to FTR included renal and respiratory failure.
• Patient factors (low income, malnutrition, comorbidities, frailty) and center factors (low volume, readmission to different hospital) were associated with increased FTR, while high-volume centers and metropolitan teaching hospitals showed protective effects.

Conclusions:

• FTR is a critical issue in LT, exhibiting considerable center-level variability.
• Patient and center-level factors are associated with FTR rates, highlighting opportunities for targeted interventions.
• Addressing modifiable predictors of FTR can enhance perioperative and postoperative care in LT.