Failure to rescue in colon surgery

Background

Major complications (MC) after colorectal surgery are not uncommon and can have serious consequences for patient survival. Failure to rescue (FTR) is an indicator used to measure the capacity for correct management of MC, calculated as the number of patients who die among all those who present MC.

Methods

Observational study with retrospective data analysis of all patients undergoing scheduled colon cancer surgery at a Spanish university hospital from September-2012 to August-2016. Preoperative, intraoperative and postoperative variables were recorded. Postoperative complications Clavien–Dindo scores > II were considered MC. FTR was defined as death within 90 postoperative days in patients with at least one MC.

Results

A total of 564 patients were included, of whom 140 (24.8%) presented MC. Of these, 22 died, representing an FTR rate of 15.7%. Patients with MC had a mean age of 69.6 years, and 30.7% were women. An open approach was used in 81.4%. Compared with survivors, the group of non-survivors presented a higher proportion of ASA III and IV (P = 0.008), a higher mean age (P = 0.001) and a higher proportion of anastomotic leaks (P = 0.009). Multivariate analysis confirmed that age (OR 1.161; P = 000), anastomotic leak (OR 18; P = 0.001) and sepsis of origin other than anastomotic leak or intra-abdominal collection (OR 26; P = 0.001) were significantly associated with FTR as independent factors.

Conclusion

The FTR rate after colectomy in our series was similar or slightly lower than other series. Age, anastomotic leakage, and sepsis of non-abdominal origin were independent factors associated with FTR. We contend that FTR is an excellent indicator of a center's ability to resolve MC. It is particularly useful for implementing measures to ensure effective treatment of MC.