Association of number and type of serious complications with failure to rescue in children undergoing surgery: A NSQIP-Pediatric analysis
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In brief
In brief
Analysis of 36,167 pediatric surgical patients found a 2.4% failure-to-rescue rate, with both the number and type of serious postoperative complications significantly associated with mortality risk. Patients experiencing two or more complications had nearly double the odds of death, suggesting opportunities for early identification of high-risk patients and targeted quality improvement interventions.
Written by the GCMD Library team from the article.
Abstract
Background
Failure to rescue (FTR) represents death after a serious complication. This study aims to determine the FTR rate in a pediatric surgical population, and if number (1 or 2+) and type of serious complications are associated with FTR.
Methods
A secondary analysis was performed using the National Surgical Quality Improvement Program Pediatric database from 2012 to 2016. Primary and secondary exposures of interest were number (1 or 2+) and type of serious complications, respectively. Propensity score analysis adjusted for baseline covariates. Primary outcome was FTR.
Results
Of 36,167 children with ≥1 serious complication, there were 851 deaths resulting in a FTR rate of 2.4%. Having 2+ serious complications was associated with higher adjusted odds of FTR (OR 1.77, 95% CI 1.52–2.08, p < 0.0001). Among those who had one complication, the type of serious complication was significantly associated with FTR. When type of initial serious complication was adjusted, number of serious complications continued to be strongly associated with FTR (OR 2.00, 95% CI 1.67–2.38, p < 0.0001).
Conclusions
FTR rate within a large, diverse, multi-specialty pediatric surgical population was 2.4%. Both number and type of postoperative complications were associated with FTR. These findings may facilitate early recognition of high-risk patients and identify quality targets for pediatric surgical centers.
Level of Evidence
Retrospective study (secondary analysis), Level II.