The "Failure to Rescue" metric as an indicator of the quality of the healthcare system organization in pancreatoduodenectomy

Pancreatoduodenectomy (PD) is characterized by a high rate of complications and mortality. The Failure to Rescue (FTR) metric, defined as mortality following major complications, is recognized as a key indicator of surgical care quality, since inter-­hospital differences in outcomes are determined by the ability to "rescue" the patient rather than by the complication rate.

Purpose of the study. To analyze current scientific data concerning the FTR metric as a marker of care quality in pancreatoduodenectomy.

Materials and methods. A literature search was conducted in the PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library databases for publications from 2000 to 2025 using the following keywords: “failure to rescue,” “pancreatoduodenectomy,” “pancreatic surgery,” “postoperative complications,” “mortality,” and “quality of care.” Eligible publications included original studies (cohort studies, case–control studies, and randomized controlled trials), systematic reviews, and meta-analyses meeting the following criteria: assessment of the failure-to-rescue (FTR) metric in patients undergoing pancreatoduodenectomy; a sample size of at least 100 patients; and a clear definition of postoperative complications and mortality.

Results. The FTR rate ranges from 4 to 41 %, depending on methodology and geographic region. Key risk factors include: age ≥ 65 years, rating on the scale of the American Society of Anesthesiologists (ASA) class ≥ 3, sarcopenic obesity, hypoalbuminemia, renal failure, shock, pancreatic fistula, and accumulation of complications. Systemic factors include low hospital surgical volume, staff shortages, and lack of 24/7 access to interventional radiology. Implementation of the PORSCH algorithm (Postoperative Standardization of Care: the Implementation of Best Practice After Pancreatic Resection) reduced 90‑day mortality from 5 to 3 % (OR 0.42). Centralization of surgery in high-volume centers, ERAS (Enhanced Recovery After Surgery) protocols, and early warning systems EWS (Early Warning Systems) significantly reduce FTR.

Conclusion. FTR is a critical quality indicator in PD. Its reduction is achieved through systemic measures: centralization of care, algorithm-based management, and ensuring access to interventional radiology. Standardization of the FTR is necessary for data comparability.

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