Failure to Rescue After Brain Tumor Resection: A National Surgical Quality Improvement Program Analysis (2012-2020).

BACKGROUND AND

OBJECTIVES

Failure to rescue (FTR) occurs when mortality happens within 30 days after a major postoperative complication. The surgical literature contains varying FTR rates based on various patient characteristics and postoperative complication rates. The impact of frailty on FTR has yet to be described within the context of brain tumor resection (BTR). Our study identified patient characteristics and postoperative complications predictive of FTR in this cohort.

METHODS

BTR patients were identified from the American College of Surgeons-National Surgical Quality Improvement Program database (2012-2020) based on craniotomy codes. Frailty was measured using the Risk Analysis Index as has been previously described.

RESULTS

There were 31 667 BTR patients and 2443 (7.71%) developed a major complication, and 387 (15.8%) experienced FTR. The median age of the cohort was 60 years (IQR 49-69). On multivariate analysis, transfer status (odds ratio [OR]: 1.36, 95% CI: 1.01-1.81) and nonelective surgery (OR: 1.60, 95% CI: 1.22-2.10) were independent predictors of FTR. Frail and severely frail patients who underwent BTR had 4.03-fold and 7.90-fold higher odds of FTR. Postoperative complications predictive of FTR were cardiac arrest (OR: 12.75, 95% CI: 8.16-19.92), unplanned reintubation (OR: 2.46, 95% CI: 1.89-3.16), and septic shock (OR: 2.02, 95% CI: 1.37-2.98). The final predictive model demonstrated excellent discriminatory accuracy (c-statistic: 0.81, 95% CI: 0.79-0.83).

CONCLUSION

Preoperative patient characteristics, including frailty, and the occurrence of certain expected postoperative complications, such as cardiac arrest, are predictive of FTR in BTR patients. Knowledge of baseline frailty could guide preoperative interventions to optimize patients before surgery.