Complications and Failure to Rescue After Inpatient Pediatric Surgery.

OBJECTIVE To describe the frequency and patterns of postoperative complications and failure to rescue (FTR) after inpatient pediatric surgical procedures and to evaluate the association between number of complications and failure to rescue. SUMMARY AND BACKGROUND FTR, or a postoperative death after a complication, is currently a nationally endorsed quality measure for adults. While it is a contributing factor to variation in mortality, relatively little is known about FTR after pediatric surgery. METHODS Cohort study of 200,554 patients within the National Surgical Quality Improvement Program-Pediatric database (2012-2016) who underwent a high (≥1%) or low (<1%) mortality risk inpatient surgical procedures. Patients were stratified based on number of postoperative complications (0, 1, 2, or ≥3) and further categorized as having undergone either a low- or high-risk procedure. The association between the number of postoperative complications and FTR was evaluated with multivariable logistic regression. RESULTS Among patients who underwent a low- (89.4%) or high-risk (10.6%) procedures, 14.0% and 12.5% had at least one postoperative complication, respectively. FTR rates after low- and high-risk procedures demonstrated step-wise increases as the number of complications accrued (e.g.: low-risk-9.2% in patients with ≥3 complications; high-risk-36.9% in patients with ≥3 complications). Relative to patients who had no complications, there was a dose-response relationship between mortality and the number of complications after low-risk (1 complication - Odds Ratio [OR] 3.34 [95% CI 2.62-4.27]; 2 - OR 10.15 [95% CI 7.40-13.92]; ≥3-27.48 [95% CI 19.06-39.62]) and high-risk operations (1 - OR 3.29 [2.61-4.16]; 2-7.24 [5.14-10.19]; ≥3-20.73 [12.62-34.04]). CONCLUSIONS There is a dose-response relationship between the number of postoperative complications after inpatient surgery and FTR, ever after common, 'minor' surgical procedures. These findings suggest FTR may be a potential quality measure for pediatric surgical care.