Failure to rescue in emergency general surgery: importance as a quality of care indicator

Abstract

Introduction: Failure to Rescue (FTR), defined as the death of a patient following the development of potentially treatable complications, has become one of the most important indicators of quality of care in surgery. In emergency general surgery, patients often present with severe clinical conditions, multiple comorbidities, and the need for urgent interventions, all of which increase the risk of postoperative complications. In this context, the institutional ability to promptly recognize clinical deterioration and initiate timely treatment has a direct impact on patient survival. Although FTR has been extensively investigated in elective surgical procedures, its role in emergency general surgery remains underexplored, representing an important area for research and improvement in healthcare delivery.

Objective: To analyze the available evidence on Failure to Rescue as a quality-of-care indicator in patients undergoing emergency general surgery.

Methodology: This integrative literature review was conducted using the PubMed, Scopus, and Virtual Health Library (VHL) databases. The descriptors “Failure to Rescue,” “Emergency General Surgery,” “Postoperative Complications,” and “Quality of Health Care” were combined using the Boolean operators AND and OR. Articles published between 2020 and 2026, available in full text and written in English, Portuguese, or Spanish, were included. Editorials, letters to the editor, case reports, and studies not directly related to emergency general surgery were excluded.

Results: The analyzed studies demonstrated that Failure to Rescue rates are closely associated with hospital infrastructure, the availability of multidisciplinary teams, continuous patient monitoring, and the prompt recognition and management of postoperative complications. Hospitals with well-established clinical protocols showed lower mortality rates despite similar complication rates. The main factors associated with increased FTR included advanced age, sepsis, septic shock, respiratory failure, the need for surgical reintervention, and delayed recognition of clinical deterioration. The implementation of rapid response systems, standardized surveillance protocols, and quality improvement initiatives was associated with significant reductions in postoperative mortality.

Conclusions: Failure to Rescue is an important quality indicator in emergency general surgery, as it assesses not only the occurrence of postoperative complications but, more importantly, the healthcare system's ability to prevent these complications from progressing to death. Strengthening clinical protocols, improving patient surveillance, and ensuring rapid responses to postoperative complications may significantly improve surgical outcomes.