Is failure to rescue an appropriate quality indicator in a pancreatic surgery unit?

Abstract

Objective

To evaluate the Failure to Rescue (FTR) rate in a pancreatic surgery unit between 2020 and 2024, and to identify the limitations of this indicator when interpreting successful outcomes.

Material and methods

A retrospective study based on a prospective database. All patients who underwent elective pancreatic surgery with curative intent between January 2020 and December 2024 were included. Preoperative, intraoperative, and postoperative clinical variables were collected. The 30- and 90-day FTR was defined as mortality among patients who experienced at least one major postoperative complication (MPC) (Clavien-Dindo ≥3).

Results

Of the 173 patients operated on, 37 (21.39%) developed major complications. The overall FTR rate was 8.11%. The most frequent complication was pancreatic fistula (17.92%), followed by intra-abdominal collections (15.03%), post-pancreatectomy haemorrhage (13.87%), and delayed gastric emptying (5.20%). The reoperation rate was 9.25%, and overall mortality was 1.73%.

Conclusion

The observed FTR rate is comparable to that of high-volume international centres. FTR, being a ratio between mortality and major complications, can be distorted in series with a low rate of such complications, which requires it to be interpreted with caution and not used as a standalone quality indicator of a surgical unit.