Failure to Rescue in Surgical Outcomes
Summary
Failure to rescue (FTR) describes the death of a patient following a recognised postoperative complication. Initially conceived as an institutional metric of surgical quality, FTR has come to embody the broader capacity of a healthcare system to detect, respond to and manage adverse events. Unlike measures that focus solely on complication rates, FTR captures the effectiveness of multidisciplinary coordination, early warning systems and critical care resources. Research over the past decade has demonstrated that FTR varies more widely between hospitals than complication incidence, suggesting that institutional practices, staffing models and escalation protocols play a decisive role. Global comparisons have identified higher FTR rates in centres with limited critical care access, while high-volume, academic and teaching hospitals often show superior rescue performance. Practical applications include targeted quality-improvement programmes, enhanced perioperative pathways and risk-adjusted benchmarking. By shifting emphasis from the occurrence of complications to their management, FTR offers a dynamic metric for continuous refinement of surgical safety and patient outcomes.
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Failure to Rescue in Surgical Outcomes publication trend
The graph below shows the total number of articles in failure to rescue in surgical outcomes across all publications each year (not limited to Nature Index journals).
Technical terms
Failure to Rescue (FTR): Death occurring after a recognised postoperative complication, used as a surgical quality metric.
Clavien–Dindo classification: A standardised grading system for postoperative complications, ranging from minor deviations to death.
American Society of Anesthesiologists (ASA) score: A preoperative scale assessing a patient’s overall health status from I (healthy) to V (moribund).
Charlson Comorbidity Index (CCI): A weighted score of pre-existing medical conditions used to predict mortality risk.
Frailty Index: A measure of a patient’s physiological reserve and vulnerability, often based on accumulated health deficits.
References
- Perioperative predictive factors of failure to rescue following highly advanced hepatobiliary-pancreatic surgery: a single-institution retrospective study. World Journal of Surgical Oncology (2023).
- Failure to Rescue in Major Abdominal Surgery: A Regional Australian Experience. World Journal of Surgery (2023).
- Risk factors for failure to rescue after hepatectomy in a high-volume UK tertiary referral center. Surgery (2024).
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