Surgery · 2026
Defining failure to rescue in emergency general surgery on the Eve of Centers for Medicare and Medicaid Services adoption: A scoping review.
Scoping ReviewСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Adeyemi Oluwaseun, Kewalramani Divya, Choron Rachel L, Teichman Amanda, Englert Zachary, Kyaw Crystal, Cai Jenny, Goswami Julie, Guven Hakan, Bharvad Dhwani, Hanna Joseph S, Pitt Henry A, Barie Philip S, Narayan Mayur
Аннотация
BACKGROUND: Failure to rescue is an established surgical quality metric. The Centers for Medicare and Medicaid Services will replace Patient Safety Indicator-04 with a new failure-to-rescue measure in 2027. However, no standardized failure-to-rescue definition exists for emergency general surgery, and evidence supporting complication inclusion is lacking. We sought to examine whether failure-to-rescue definitions vary across emergency general surgery studies, how these definitions align with national frameworks, and characterize complication-mortality associations.
METHODS: A scoping review was conducted across 5 databases (2000-2025). Studies examining failure to rescue in adult emergency general surgery populations were included. Concordance between study-defined complications and established frameworks (Patient Safety Indicator-04, National Surgical Quality Improvement Program, and Centers for Medicare and Medicaid Services) was assessed. Odds ratios for complication-mortality associations were extracted.
RESULTS: Among 23 studies, failure-to-rescue definitions included a mean of 12 complications (range 7-19), with 38 unique complications identified. Framework concordance was low: Patient Safety Indicator-04 47%, National Surgical Quality Improvement Program 43%, and Centers for Medicare and Medicaid Services 18%. Of Centers for Medicare and Medicaid Services failure-to-rescue complications, 45% have never been studied in emergency general surgery. Failure-to-rescue rates ranged 4.9%-21.4% and higher among geriatric cohorts (11.6%-29.9%). Complication odds ratios were rarely reported (14.5%); among those, acute respiratory distress syndrome (odds ratio, 6.7), disseminated intravascular coagulopathy (odds ratio, 4.9), sepsis (odds ratio, 1.4-7.6), and pneumonia (odds ratio, 1.9-8.7) demonstrated the strongest mortality associations, whereas deep venous thrombosis and surgical site infections showed inverse associations.
CONCLUSION: Emergency general surgery failure to rescue suffers from heterogeneity, as complications determining failure-to-rescue definitions vary widely. Emergency general surgery-specific validation or exclusion from the Centers for Medicare and Medicaid Services 2027 measure warrants consideration.
METHODS: A scoping review was conducted across 5 databases (2000-2025). Studies examining failure to rescue in adult emergency general surgery populations were included. Concordance between study-defined complications and established frameworks (Patient Safety Indicator-04, National Surgical Quality Improvement Program, and Centers for Medicare and Medicaid Services) was assessed. Odds ratios for complication-mortality associations were extracted.
RESULTS: Among 23 studies, failure-to-rescue definitions included a mean of 12 complications (range 7-19), with 38 unique complications identified. Framework concordance was low: Patient Safety Indicator-04 47%, National Surgical Quality Improvement Program 43%, and Centers for Medicare and Medicaid Services 18%. Of Centers for Medicare and Medicaid Services failure-to-rescue complications, 45% have never been studied in emergency general surgery. Failure-to-rescue rates ranged 4.9%-21.4% and higher among geriatric cohorts (11.6%-29.9%). Complication odds ratios were rarely reported (14.5%); among those, acute respiratory distress syndrome (odds ratio, 6.7), disseminated intravascular coagulopathy (odds ratio, 4.9), sepsis (odds ratio, 1.4-7.6), and pneumonia (odds ratio, 1.9-8.7) demonstrated the strongest mortality associations, whereas deep venous thrombosis and surgical site infections showed inverse associations.
CONCLUSION: Emergency general surgery failure to rescue suffers from heterogeneity, as complications determining failure-to-rescue definitions vary widely. Emergency general surgery-specific validation or exclusion from the Centers for Medicare and Medicaid Services 2027 measure warrants consideration.