Determinants of Failure to Rescue After Pulmonary Resection for Lung Cancer: Insights From a National Inpatient...

Failure to rescue (FTR), defined as death following a postoperative complication, is an established quality metric; however, national data after pulmonary resection remain limited. We aim to identify patient-, procedural-, and hospital-level factors associated with FTR after pulmonary resection for lung cancer and evaluate related outcomes.

The National Inpatient Sample (2016-2022) was used to identify adults undergoing elective pulmonary resection for lung cancer who developed ≥ 1 major complication. FTR was defined as in-hospital mortality. Multivariable logistic regression identified predictors. Secondary outcomes included length of stay, costs, and discharge disposition.

Among 14,575 patients with major complications, FTR occurred in 2.6%. Frailty (OR 3.44, 95% CI 2.73-4.35) and comorbidity burden (Elixhauser ≥ 2: OR 4.87, 1.54-15.43) were the strongest predictors. Pneumonectomy (OR 2.78, 1.82-4.23), age ≥ 75 years (OR 2.21, 1.47-3.32), and open approach (OR 1.78, 1.41-2.24) were also associated, while female sex and private insurance were protective. No hospital factors were independently associated.

FTR is driven by patient vulnerability and procedural complexity rather than hospital characteristics. These findings emphasize preoperative risk stratification and complication management in high-risk patients but do not support regionalization to high-volume centers as a strategy to reduce FTR.