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Hospital factors associated with failure to rescue after surgery: meta-analysis
Cameron I Wells1, Surya Akash Boppana1, Chris Varghese1,2
1Department of Surgery, The University of Auckland, Auckland, New Zealand.
BJS Open
|July 16, 2026
Summary
Hospital characteristics significantly impact failure to rescue (FTR) rates, a key factor in postoperative mortality. Larger hospitals with better nursing resources and ICU capacity show lower FTR, highlighting the importance of hospital organization and resources.
Area of Science:
- Healthcare Management
- Surgical Outcomes Research
- Health Services Research
Background:
- Failure to rescue (FTR) is a critical determinant of postoperative mortality, reflecting a hospital's capacity to manage patient complications.
- Significant variations in FTR exist between hospitals, yet the underlying hospital characteristics driving these differences are not consistently defined.
Purpose of the Study:
- To systematically review and synthesize evidence on hospital-level factors associated with FTR after postoperative complications.
- To identify structural, staffing, and system characteristics that influence FTR across diverse surgical populations and healthcare systems.
Main Methods:
- A systematic review of observational studies was conducted, searching MEDLINE, EMBASE, and Scopus.
- Hospital factors were categorized into structural, staffing, and system domains.
- Random-effects meta-analyses were performed where data permitted; otherwise, findings were narratively summarized. Study quality was assessed using ROBINS-I.
Main Results:
- 111 studies including over 137 million patients identified 301 hospital factors.
- Lower FTR was associated with larger hospitals, greater ICU capacity, and teaching hospital status.
- Improved nursing resources (staffing levels, education, work environment) correlated with lower FTR, while safety-net hospital status was linked to higher FTR.
Conclusions:
- Hospital structural, staffing, and system characteristics are significantly associated with variations in failure to rescue.
- Effective detection and management of postoperative complications are crucial for reducing mortality, emphasizing the need for adequate hospital resources and organized systems.
