Analysis of failure to rescue in adult patients who undergo open, proximal aortic repair

Objective: Failure to rescue (FTR) is a metric of postoperative care, measuring a center’s ability to prevent operative death after a surgical complication. We evaluated trends in and contributors to FTR after proximal aortic surgery at a high-volume institution. Methods: Of 4180 patients in our single practice who underwent open proximal aortic repair from 1990 to 2024, 1304 (31.2%) had at least 1 of 4 FTR-related complications identified by the Society of Thoracic Surgeons (STS). Operative death was defined as death within 30 days of surgery or before hospital discharge or transfer. We analyzed FTR rate by specific complication, including the number and combination of complications. We then evaluated the association of elective versus emergency repair and aortic dissection with FTR rate. Finally, a multivariable model was built to predict FTR in these patients. Results: Of 1304 patients with an STS complication, 303 (23.2%) had operative death and thus an FTR. The FTR rate was 13% for patients with 1 complication and increased to 48%, 68%, and 100% with each additional complication. The 2 STS complications most associated with FTR were stroke (odds ratio, 5.92; P < .001) and renal failure necessitating dialysis (odds ratio, 8.24; P < .001). Neither emergency repair nor acute aortic dissection were significant FTR predictors after adjustment for covariates. A 6-variable predictive model to predict FTR achieved a test C-statistic of 0.79 (0.77-0.81). Conclusions: The FTR rate significantly increased with each additional complication. We built a model that can effectively predict FTR. Better understanding of FTR rates can identify areas for improvement in postoperative care.