Failure to Rescue, Rescue Surgery and Centralization of Postoperative Complications: A Challenge for General and Acute Care Surgeons

Abstract

Scop: De a explora literatura de specialitate actuală în ceea ce priveşte conceptele imposibilităţii de salvare şi al chirurgiei de salvare, în vederea identificării elementelor cheie pentru reducerea ratei de imposibilitate de salvare şi îmbunătăţirii rezultatelor, precum şi a verificării existenţei unei justificări pentru centralizarea pacienţilor care suferă complicaţii postoperatorii. Descoperiri recente: Este tot mai cunoscută necesitatea evaluării şi estimării ratei imposibilităţii de salvare la nivel de instituţii, regional şi naţional. Numeroşi factori influenţează imposibilitatea de salvare, iar toţi aceştia ar trebui luaţi în considerare şi analizaţi individual. Chirurgia de salvare reprezintă unul dintre aceşti factori. Chirurgia de salvare presupune un context de tratament chirurgical de urgenţă. Concluzii: Măsurarea ratei de imposibilitate de salvare ar trebui să devină un standard în programele de îmbunătăţire a calităţii. Implementarea tuturor factorilor clinici şi organizatorici implicaţi este cheia obţinerii unor rezultate mai bune. Gradul de pregătire pentru chirurgia de salvare reprezintă un pilon principal în acest proces. Centralizarea datelor privind managementul, auditul şi comunicarea este la fel de importantă precum centralizarea pacienţilor.

Failure to Rescue (FTR) and Pitfalls in the Management of Complex Enteric Fistulas (CEF): From Rescue Surgery to Rescue Strategy

“…Although the complication rate is not different between low-and high-volume hospitals, there is a dramatic difference in FTR rates in favour of high-volume hospitals. The same evidence was reported in a review by Zago et al Acute care surgeons in referral centres have higher non-technical skills and the ability to coordinate with multidisciplinary teams [3,12].…”

“…The definition of the FTR rate is not universal and relies on the nature of the population considered. Different definitions have been proposed [3,12].…”

“…The ability of ACS to deliver urgent and tailored care is essential to surgical rescue. Some authors have recently published papers addressing the importance of integrating rescue surgery as a pillar of acute care surgery, trauma, emergency surgery, and critical care [1][2][3][4][5][6].…”

“…It is difficult to rescue patients with CEF because surgical factors are not the critical ones for definitive care. The contributing factors to rescue the patient embrace a multidisciplinary team, including nutrition, infectious disease, critical care, and psychology professionals and implementation of different bedside surgical techniques for CEF control [3,[6][7][8].…”

A 10-Year Evaluation of Short-Term Outcomes After Synchronous Colorectal Cancer Surgery: a Dutch Population-Based Study

“…Failure to rescue is considered a team effort in CRC surgery. 28 , 29 For this reason, CRC was analyzed as one group. For pathological outcomes, the tumor-free resection margin rate was evaluated, defined as a tumor-free bowel resection margin as well as a tumor-free retroperitoneal resection margin for colon cancer and negative circumferential resection margin for rectal cancer (> 1 mm).…”