Pre-operative risk factors including ASA score ≥3, CCI ≥3, and serum albumin <35 g/L significantly increased the risk of failure to rescue (23.5% overall) after major abdominal surgery.
Cohort (n=2,579)
No
What are the pre-operative and operative risk factors associated with failure to rescue following major abdominal surgery?
Pre-operative factors such as ASA score ≥ 3, CCI ≥ 3, and low serum albumin are significant predictors of failure to rescue in patients undergoing major abdominal surgery.
BACKGROUND: Failure to rescue (FTR) is increasingly recognised as a measure of the quality care provided by a health service in recognising and responding to patient deterioration. We report the association between a patient's pre-operative status and FTR following major abdominal surgery. METHODS: A retrospective chart review was conducted on patients who underwent major abdominal surgery and who suffered Clavien-Dindo (CDC) III-V complications at the University Hospital Geelong between 2012 and 2019. For each patient suffering a major complication, pre-operative risk factors including demographics, comorbidities (Charlson Comorbidity Index (CCI)), American Society of Anaesthesiology (ASA) Score and biochemistry were compared for patients who survived and patients who died. Statistical analysis utilised logistic regression with results reported as odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: There were 2579 patients who underwent major abdominal surgery, of whom 374 (14.5%) suffered CDC III-V complications. Eighty-eight patients subsequently died from their complication representing a 23.5% FTR and an overall operative mortality of 3.4%. Pre-operative risk factors for FTR included ASA score ≥ 3, CCI ≥ 3 and pre-operative serum albumin of < 35 g/L. Operative risk factors included emergency surgery, cancer surgery, greater than 500 ml intraoperative blood loss and need for ICU admission. Patients who suffered end-organ failure were more likely to die from their complication. CONCLUSION: Identification of patients at high risk of FTR should they develop a complication would inform shared decision-making, highlight the need for optimisation prior to surgery, or in some cases, result in surgery not being undertaken.
Divakaran et al. (Wed,) conducted a cohort in Major abdominal surgery with severe complications (n=2,579). Risk factor assessment (ASA score, CCI, serum albumin) was evaluated on Failure to rescue (FTR). Pre-operative risk factors including ASA score ≥3, CCI ≥3, and serum albumin <35 g/L significantly increased the risk of failure to rescue (23.5% overall) after major abdominal surgery.