Technological innovations for the early detection of postoperative deterioration after adult noncardiac surgery: the chain of rescue as a framework for understanding failure to rescue

Background Postoperative complications after adult noncardiac surgery are frequent and strongly associated with mortality, prolonged morbidity, functional decline, and organizational burden. Because not all complications are preventable, failure to rescue has emerged as a central concept reflecting the capacity of healthcare organizations to recognize and treat deterioration in time. Methods We conducted a critical narrative review using SANRA as a quality self-appraisal framework. MEDLINE/PubMed, Embase, and the Cochrane Library were searched for publications from 2000 to 2026, complemented by backward and forward citation tracking. The review focused on adult, non-obstetric patients recovering after noncardiac surgery, primarily in general surgical wards. Results Perioperative risk models, early warning scores, electronic health record-integrated and artificial intelligence-enabled systems, and continuous monitoring devices have improved the acquisition and integration of physiological and clinical information. However, prediction and detection do not themselves establish clinical effectiveness. These technologies primarily strengthen signal acquisition, recognition, and alert generation, whereas patient benefit depends on timely reassessment, diagnostic interpretation, escalation, treatment, and available response resources. Implementation studies improve process outcomes more consistently than patient-important outcomes. Benefit is most apparent when surveillance is linked to an explicit, procedure-specific diagnostic and therapeutic pathway. Human and organizational factors influence every stage of this process. Discussion Postoperative rescue is a sociotechnical process rather than a purely technological intervention. Current evidence supports linking deterioration alerts to explicit and adequately resourced response pathways, but effects on mortality, serious complications, disability, and recovery remain uncertain. Future studies should combine component-level and integrated-system evaluation while incorporating patient-important, process, and staff outcomes.