Perioperative predictive factors of failure to rescue following highly advanced hepatobiliary- pancreatic surgery

Abstract

Abstract Background Failure to rescue (FTR), defined as a postoperative complication leading to mortality, is a recently described outcome metric used to evaluate treatment quality. However, the predictive factors for FTR, particularly following highly advanced hepatobiliary-pancreatic surgery (HBPS), have not been adequately investigated. This study aimed to identify perioperative predictive factors for FTR following highly advanced HBPS. Methods This single-institution retrospective study involved 177 patients at Gifu University Hospital who developed severe postoperative complications (Clavien-Dindo classification ≥ grade 3a) between 2010 and 2022 following highly advanced HBPS. Logistic regression analysis was used to identify pre-, intra-, and postoperative risks of FTR. Results Nine postoperative mortalities occurred during the study period (overall mortality rate, 1.3% [9/686]; FTR rate, 5.1% [9/177]). Univariate analysis indicated that comorbid liver disease, intraoperative blood loss, intraoperative blood transfusion, postoperative liver failure, postoperative respiratory failure, and postoperative bleeding significantly correlated with FTR. Multivariate analysis indicated that intraoperative blood loss > 1600 mL (odds ratio [OR] 1.12e + 9; 95% confidence interval [CI] 34.87–; p < 0.001) and postoperative respiratory failure (OR 2.29e + 8; 95% CI 15.53–; p < 0.001) were independently associated with FTR. Conclusions FTR was found to be associated with hospital-related factors and may be associated with perioperative factors. Prevention of massive intraoperative blood loss and postoperative respiratory failure may decrease FTR rates.