Clinical Report: Predictors of Failure to Rescue in Surgical Rescue Patients

Overview

This retrospective study of 142 emergency surgery patients identified key predictors of failure to rescue (FTR) including ASA-PS ≥ 3, qSOFA score ≥ 2, and complications from non-surgical therapy. A Surgical Rescue Severity Score (SRSS) was developed from these predictors and effectively stratified both short- and long-term patient prognoses.

Background

Failure to rescue (FTR) refers to mortality following complications in surgical patients and is a critical quality metric in acute care surgery. While predictors of FTR have been studied in trauma patients, data on surgical rescue (SR) patients remain limited. Identifying factors associated with FTR in SR can improve risk stratification and guide clinical decision-making. This study aimed to determine current FTR predictors in SR and develop a scoring system to predict outcomes.

Data Highlights

Key Findings

• ASA-PS score ≥ 3 is an independent predictor of failure to rescue with an odds ratio of 5.3.
• qSOFA score ≥ 2 independently predicts FTR with an odds ratio of 4.5.
• Complications caused by non-surgical therapy significantly increase the risk of FTR (OR 5.5).
• Patients requiring surgical treatment as part of rescue had better survival outcomes.
• The Surgical Rescue Severity Score (SRSS), based on these predictors, stratifies both short- and long-term prognosis effectively.

Clinical Implications

Clinicians should assess ASA-PS and qSOFA scores preoperatively to identify patients at high risk of failure to rescue. Awareness of complications from non-surgical therapy is critical in managing surgical rescue patients. The SRSS can be used as a practical tool to guide perioperative decision-making and resource allocation to improve outcomes.

Conclusion

ASA-PS ≥ 3, qSOFA ≥ 2, and non-surgical therapy complications are key predictors of failure to rescue in surgical rescue patients. The SRSS provides a valuable prognostic tool for stratifying patient risk and guiding clinical management.

References

1. Kutcher ME et al. 2017 -- Surgical rescue: the next pillar of acute care surgery
2. Peitzman AB et al. 2015 -- Surgical rescue: an essential component of acute care surgery
3. Abe T et al. 2020 -- Trauma complications and in-hospital mortality: failure-to-rescue
4. Bellomo R et al. 2016 -- The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)