Bridging the Age Gap: Failure-to-Rescue rates in patients undergoing Radical Cystectomy

Abstract Purpose Radical cystectomy (RC) for bladder cancer carries substantial morbidity, with 30-day mortality rates often reported at 2–3%. “Failure-to-rescue” (FTR) – defined as death following one or more major postoperative complications – has emerged as a key quality metric in surgery. We used the ACS-NSQIP dataset to quantify 30-day FTR after RC and identify its predictors. Methods We retrospectively analyzed ACS-NSQIP (2019–2022) to identify 11,062 adults undergoing elective RC for malignancy. Patients were separated into age groups by percentiles, < 62 (25th percentile), 62–76 (25th – 75th percentile), and > 76 (75th percentile). We defined major complications as Clavien Dindo grade ≥ III. FTR was defined as 30-day mortality among patients with ≥ 1 major complication. We performed multivariable logistic regression to identify independent predictors of FTR while adjusting for patient demographics and comorbidities. Results The 30-day mortality was 1.4%, with 10.5% sustaining ≥ 1 major complication. FTR occurred at a rate of 9.51% overall, with older age groups (> 76) showing higher FTR rates (16.06%) while lower age groups were much lower, age < 62 (5.65%) and age 62–76 (7.09%). Multivariable analysis identified older age (> 76 years) associated with significantly higher FTR (OR 2.884, p-value = < 0.001) while middle age groups did not see a significant increase of FTR after developing major complications (OR 1.234, p-value = 0.504). Conclusions Older patients undergoing cystectomy were associated with greater failure-to-rescue rates. These findings complement prior studies showing that hospital and patient factors influence FTR. Interventions to improve early complication recognition and rescue may reduce FTR and improve survival after RC.