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Invited Commentary
November 2015

Failure to Rescue Metric in Lung Surgery: A Needed Breath of Fresh Air

Author Affiliations
  • 1Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City
JAMA Surg. 2015;150(11):1040-1041. doi:10.1001/jamasurg.2015.2237

The performance of surgical procedures is inevitably associated with complications. The holy grail in assessing surgical quality is differentiating metrics that reflect the care a hospital and surgical team delivers (factors that can be improved) from those that are solely related to a patient’s medical comorbidities (factors often beyond our control). In the landmark article introducing the concept, Silber and colleagues1 demonstrated that although mortality and the occurrence of adverse events could be attributed to patient characteristics, the key finding was that the failure to rescue (FTR) patients from death once an adverse event had occurred was associated more with hospital characteristics and was less influenced by patient admission severity of illness. Since then, a body of literature has emerged assessing FTR in select surgical procedures2-4 as well as the variation in the quality of response to adverse events.5 In studying patients who have already developed a complication, the specifics of adjustment for comorbidities become less important in failure analyses because with the development of complications, patients are more uniformly ill.