Clinical Scorecard: Identifying Factors Associated with Surgical Rescue Failure

At a Glance

Key Highlights

• ASA-PS ≥ 3, qSOFA score ≥ 2, and complications caused by non-surgical therapy are independent predictors of failure to rescue.
• Development of a Surgical Rescue Severity Score (SRSS) stratifies short- and long-term prognosis of surgical rescue patients.
• SRSS can predict patient prognosis preoperatively, aiding clinical decision-making.

Guideline-Based Recommendations

Diagnosis

• Assess ASA-PS score preoperatively to evaluate patient physical status.
• Use qSOFA scoring to identify organ failure risk in emergency surgical patients.
• Identify complications caused by non-surgical therapy as a risk factor for FTR.

Management

• Prioritize surgical treatment as a cause for surgical rescue when possible to improve survival.
• Implement strategies to minimize non-surgical therapy complications.
• Use SRSS to guide risk stratification and tailor perioperative care.

Monitoring & Follow-up

• Closely monitor patients with ASA-PS ≥ 3 and qSOFA ≥ 2 for early signs of deterioration.
• Track complications related to non-surgical therapy during postoperative care.
• Use SRSS score to monitor and predict long-term outcomes.

Risks

• Higher ASA-PS and qSOFA scores significantly increase odds of failure to rescue.
• Non-surgical therapy complications independently raise mortality risk.
• Failure to rescue is associated with both short- and long-term mortality.

Patient & Prescribing Data

Emergency surgery patients undergoing surgical rescue

Patients with higher ASA-PS and qSOFA scores and those experiencing non-surgical therapy complications require intensified perioperative management to reduce failure to rescue risk.

Clinical Best Practices

• Evaluate ASA-PS and qSOFA scores preoperatively to identify high-risk patients.
• Develop and apply the Surgical Rescue Severity Score (SRSS) for risk stratification.
• Focus on preventing and managing complications from non-surgical therapies.
• Use SRSS to inform clinical decisions and improve both short- and long-term outcomes.

References

• Moore EE (2007) Acute care surgery: the safety net hospital model
• Jurkovich GJ (2011) Acute care surgery: concept, practice and training
• Kutcher ME et al (2017) Surgical rescue: the next pillar of acute care surgery
• Peitzman AB et al (2015) Surgical rescue: an essential component of acute care surgery
• Silber JH et al (1992) Hospital and patient characteristics associated with death after surgery
• Abe T et al (2020) Trauma complications and in-hospital mortality: failure-to-rescue
• Bellomo R et al (2016) The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
• Briggs A, Peitzman AB (2018) Surgical rescue in medical patients: the role of acute care surgeons
• Ghaferi AA et al (2009) Complications, failure to rescue, and mortality with major inpatient surgery
• Khalil M et al (2015) Certified acute care surgery programs improve outcomes in emergency surgery
• Schuster KM et al (2021) Association of acute care surgeon experience with emergency surgery outcomes
• Yuan Y et al (2021) Influence of ASA Score on Oncologic Outcomes in Upper Tract Urothelial Carcinoma