Failure to Rescue and Lung Resections for Lung Cancer: Measuring Quality from the Operation Room to the Intensive...

Area of Science:

• Thoracic Surgery
• Surgical Quality Improvement
• Patient Safety

Background:

• Failure to rescue (FTR), defined as death after a treatable postoperative complication, is a key quality metric in thoracic surgery.
• Patients undergoing lung cancer resection face high risks due to comorbidities and limited pulmonary reserve, making FTR a significant factor in outcomes.
• Current FTR models focus on clinical interventions but often neglect essential institutional and cultural changes for sustained improvement.

Purpose of the Study:

• To explore the multifactorial nature of FTR in lung cancer surgery.
• To identify patient-related and system-level risk factors contributing to FTR.
• To propose a novel roadmap for reducing FTR by integrating evidence with Kotter's eight-step change model.

Main Methods:

• Review of existing literature on FTR in thoracic surgery, particularly lung cancer resection.
• Analysis of patient-related and system-level risk factors.
• Integration of Kotter's eight-step change model to develop a strategic roadmap.

Main Results:

• FTR is influenced by surgical complexity, delayed complication recognition, inadequate care escalation, and limited critical care resources.
• Existing rescue models are insufficient without addressing institutional and cultural factors.
• A multidimensional roadmap involving proactive monitoring, structured escalation, multidisciplinary coordination, and continuous learning is proposed.

Conclusions:

• Reducing FTR in lung cancer resection demands more than clinical responsiveness.
• A systemic transformation is necessary, aligning frontline practice with institutional readiness and a robust safety culture.
• Implementing proactive strategies and fostering a culture of safety are crucial for improving patient outcomes and reducing mortality.