Failure-to-rescue after acute complications in gastrointestinal cancer hospitalizations in the United States, 2018–2022.

e23118 Background: Inpatient mortality among gastrointestinal (GI) cancer hospitalizations may be influenced not only by the occurrence of acute complications, but also by differences in the ability to rescue patients once complications develop. National data describing failure-to-rescue patterns across hospital settings in GI oncology are limited. Methods: A serial cross-sectional analysis was conducted using the 2018–2022 Healthcare Cost and Utilization Project National Inpatient Sample. Adult hospitalizations with a principal diagnosis of esophageal, gastric, colorectal, liver or intrahepatic bile duct, or pancreatic cancer were identified. Acute complications were defined using secondary diagnosis codes for bowel obstruction, perforation, gastrointestinal bleeding, and sepsis, combined into an “any complication” indicator. Failure-to-rescue was defined as in-hospital mortality among hospitalizations with at least one acute complication. National estimates accounted for survey weighting, clustering, and stratification. Complication incidence, overall mortality, and failure-to-rescue were summarized by hospital teaching status, bed size, and geographic region. Survey-weighted multivariable logistic regression, restricted to complicated hospitalizations, evaluated factors independently associated with in-hospital mortality. Results: Among GI cancer hospitalizations, 23.1% experienced at least one acute complication. Overall in-hospital mortality was 4.03%, while mortality among hospitalizations with complications was 7.38%. Complication incidence was similar across hospital teaching status, bed size, and region, whereas overall mortality varied across hospital types. Failure-to-rescue among complicated hospitalizations ranged from approximately 6.8% to 9.1% across hospital size and geographic region. In adjusted analyses restricted to complicated hospitalizations, increasing age was associated with higher odds of in-hospital mortality, while female sex was associated with lower mortality. After adjustment, hospital teaching status was not independently associated with failure-to-rescue, whereas hospital bed size and region remained associated with mortality among complicated hospitalizations. Conclusions: Across GI cancer hospitalizations, nearly one-quarter were complicated by acute events, and mortality increased substantially once complications occurred. Although complication incidence was similar across hospital settings, failure-to-rescue varied by hospital size and region. These nationally representative findings provide benchmarking data on rescue outcomes following acute complications in GI oncology.