Identification of Patients With Postoperative Complications Who Are at Risk for Failure to Rescue

Abstract

Twenty percent of high-risk patients account for 90% of failure to rescue (Pareto principle). More than two-thirds of patients with failure to rescue have multiple complications. On average, a few days elapse before death following a complication. A risk-scoring system based on preoperative variables predicts patients in the highest-risk category of failure to rescue with good accuracy. In high-risk patients who develop complications, our results suggest that early intervention, preferably in a high-level intensive care facility with a surgical training program, offers the best chance to reduce failure-to-rescue rates.

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“…The term 'failure to rescue' attempts to take into account that it is not the occurrence of complications per se but rather the handling of these that is important. It also describes the disease-specific mortality after operative interventions as an important hospital quality parameter [45][46][47][48]. The use of trained personnel and specialization in intensive care units are also crucial [49].…”

Surgical Apgar score in prediction of post-operative complications in gynecological surgery

“…Surgeries, of course, come with a host of risks, including death. 3 In addition to the expected risks such as bleeding, infection and anesthetic problems, gynaecological surgeries pose a set of unique risks. Due to the close proximity of the female genital organs to the bowel and urinary tract, gynecological surgeries present risks for intra-operative injury to the ureters, bladder and bowel as well as the major pelvic blood vessels.…”

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“…43 In addition, they showed that cardiac events, pulmonary failure, renal failure, and stroke tended to have much higher failure-to-rescue rates, most of which occurred one week before post-operative mortality. 43 These findings are consistent with our data, suggesting that a frequent observation and timely intervention can potentially reduce failure to rescue during the limited period for rescue. A variety of factors are known to decrease the failure-to-rescue rate, such as aggressive and extreme interventions, and high-quality structural components, including better ICU care, nurse to patient ratios, involvement of residents and subspecialty surgeons, and effective teamwork.…”

“…Ferraris et al (2014) discussed the importance of identifying the minority of patients who were likely to die so that more intensive postoperative care can be provided for them to reduce the failure-to-rescue rate. 43 In addition, they showed that cardiac events, pulmonary failure, renal failure, and stroke tended to have much higher failure-to-rescue rates, most of which occurred one week before post-operative mortality. 43 These findings are consistent with our data, suggesting that a frequent observation and timely intervention can potentially reduce failure to rescue during the limited period for rescue.…”

“…A variety of factors are known to decrease the failure-to-rescue rate, such as aggressive and extreme interventions, and high-quality structural components, including better ICU care, nurse to patient ratios, involvement of residents and subspecialty surgeons, and effective teamwork. 43 In clinical settings, one of the major decisions evolves around when to intervene more aggressively. Based on our clinical experience, we believe that earlier reoperative management may have resulted in better clinical outcomes than the later ones, reducing the failureto-rescue rate.…”