Wells Cameron I, Bhat Sameer, Xu William, Varghese Chris, Keane Celia, Baraza Wal, O'Grady Greg, Harmston Chris, Bissett Ian P
Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.
Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora MidCentral, Palmerston North, New Zealand.
Surgery. 2024 Apr;175(4):1103-1110. doi: 10.1016/j.surg.2023.12.006. Epub 2024 Jan 19.
Failure to rescue is the rate of death amongst patients with postoperative complications and has been proposed as a perioperative quality indicator. However, variation in its definition has limited comparisons between studies. We systematically reviewed all surgical literature reporting failure to rescue rates and examined variations in the definition of the 'numerator,' 'denominator,' and timing of failure to rescue measurement.
Databases were searched from inception to 31 December 2022. All studies reporting postoperative failure to rescue rates as a primary or secondary outcome were included. We examined the complications included in the failure to rescue denominator, the percentage of deaths captured by the failure to rescue numerator, and the timing of measurement for complications and mortality.
A total of 359 studies, including 212,048,069 patients, were analyzed. The complications included in the failure to rescue denominator were reported in 295 studies (82%), with 131 different complications used. The median number of included complications per study was 10 (interquartile range 8-15). Studies that included a higher number of complications in the failure-to-rescue denominator reported lower failure-to-rescue rates. Death was included as a complication in the failure to rescue the denominator in 65 studies (18%). The median percentage of deaths captured by the failure to rescue calculation when deaths were not included in the denominator was 79%. Complications (52%) and mortality (40%) were mostly measured in-hospital, followed by 30-days after surgery.
Failure to rescue is an important concept in the study of postoperative outcomes, although its definition is highly variable and poorly reported. Researchers should be aware of the advantages and disadvantages of different approaches to defining failure to rescue.
未能挽救是指术后并发症患者的死亡率，已被提议作为围手术期质量指标。然而，其定义的差异限制了不同研究之间的比较。我们系统回顾了所有报告未能挽救率的外科文献，并研究了“分子”“分母”定义以及未能挽救测量时间的差异。
检索数据库，时间范围从建库至2022年12月31日。纳入所有将术后未能挽救率作为主要或次要结局的研究。我们检查了未能挽救分母中包含的并发症、未能挽救分子所涵盖的死亡百分比，以及并发症和死亡率的测量时间。
共分析了359项研究，涉及212,048,069名患者。295项研究（82%）报告了未能挽救分母中包含的并发症，共使用了131种不同的并发症。每项研究纳入并发症的中位数为10种（四分位间距8 - 15）。未能挽救分母中纳入并发症数量较多的研究报告的未能挽救率较低。65项研究（18%）将死亡作为未能挽救分母中的并发症。当分母中未包含死亡时，未能挽救计算所涵盖的死亡中位数百分比为79%。并发症（52%）和死亡率（40%）大多在住院期间测量，其次是术后30天。
未能挽救是术后结局研究中的一个重要概念，尽管其定义高度可变且报告不佳。研究人员应了解不同未能挽救定义方法的优缺点。
