Zotos Prokopis-Andreas, Androutsopoulou Vasiliki, Scarci Marco, Minervini Fabrizio, Cioffi Ugo, Xanthopoulos Andrew, Athanasiou Thanos, Magouliotis Dimitrios E
Department of Cardiothoracic Surgery, University of Thessaly, Biopolis, 41110 Larissa, Greece.
Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare, National Health Service (NHS) Trust, London W12 0HS, UK.
Cancers (Basel). 2025 Aug 26;17(17):2784. doi: 10.3390/cancers17172784.
Failure to rescue (FTR), defined as death following a potentially treatable postoperative complication, has emerged as a critical quality metric in thoracic surgery. In patients undergoing lung cancer resection, who are often at high risk due to comorbidities and limited pulmonary reserve, FTR significantly influences morbidity, mortality, recovery, and overall quality of life. This review explores the multifactorial nature of FTR in lung cancer surgery, highlighting key patient-related and system-level risk factors, such as surgical complexity, delayed complication recognition, inadequate escalation of care, and limited critical care resources. Existing models for patient rescue emphasize early detection and timely intervention, but often overlook the institutional and cultural changes required for sustainable improvement. Building on current evidence and integrating Kotter's eight-step change model, we propose a novel multidimensional roadmap to reduce FTR through proactive monitoring, structured escalation protocols, multidisciplinary coordination, and continuous learning. Finally, reducing FTR in lung cancer resection requires more than clinical responsiveness. This necessitates a systemic transformation that aligns frontline practice with institutional readiness and a culture of safety.
未能成功挽救（FTR）被定义为在术后出现潜在可治疗并发症后死亡，已成为胸外科一项关键的质量指标。在接受肺癌切除术的患者中，由于合并症和肺储备有限，他们往往处于高风险状态，FTR会显著影响发病率、死亡率、恢复情况以及整体生活质量。本综述探讨了肺癌手术中FTR的多因素性质，强调了关键的患者相关和系统层面的风险因素，如手术复杂性、并发症识别延迟、护理升级不足以及重症监护资源有限。现有的患者挽救模型强调早期检测和及时干预，但往往忽视了实现可持续改善所需的机构和文化变革。基于当前证据并整合科特的八步变革模型，我们提出了一个新颖的多维路线图，通过主动监测、结构化升级方案、多学科协调和持续学习来降低FTR。最后，降低肺癌切除术中的FTR需要的不仅仅是临床反应能力。这需要进行系统性变革，使一线实践与机构准备情况和安全文化保持一致。
