Association of risk analysis index with 90-day failure to rescue following major abdominal surgery in geriatric patients

• Published in: Journal of gastrointestinal surgery 2024-03, Vol.28 (3), p.215-219
• Main Authors: Sutherland, Grant N., Cramer, Christopher L., Clancy III, Paul W., Huang, Minghui, Turkheimer, Lena M., Tran, Christine A., Turrentine, Florence E., Zaydfudim, Victor M.
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Aged; Failure to rescue; Frailty; Frailty - complications; Geriatric; Humans; Major abdominal surgery; Odds Ratio; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Quality Improvement; Risk analysis index
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1016/j.gassur.2023.12.012

Failure to rescue (FTR) is a quality metric defined as mortality after potentially preventable complications after surgery. Predicting patients who are at the highest risk of mortality after a complication may aid in preventing deaths. Thirty-day follow-up period inadequately captures postoperative deaths; alternatively, a 90-day follow-up period has been advocated. This study aimed to examine the association of a validated frailty metric, the risk analysis index (RAI), with 90-day FTR (FTR-90). Patients aged ≥65 years who underwent a major abdominal operation between 2014 and 2020 at a quaternary care center were abstracted. Institutional data were merged with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) and Geriatric Surgery Research File variables. The association between RAI and FTR-90 was evaluated using multivariable logistic regression. A total of 398 patients with postoperative complications were included. Fifty-two patients (13.1%) died during the 90-day follow-up. The FTR-90 group was older (median age: 76 vs 73 years, respectively; P = .002), had a greater preoperative American Society of Anesthesiologists classification score (P