Peri-operative predictive factors of failure to rescue after highly advanced hepatobiliary-pancreatic surgery.

39 Background: Failure to rescue (FTR), defined as postoperative complications leading to mortality, is a recently described outcome metric to evaluate the quality of treatment. However, predictive factors of FTR, particularly after highly advanced hepatobiliary-pancreatic surgery (HBPS), have not been adequately investigated. Thus, it remains unclear. The object of this study is to identify the perioperative predictive factors of FTR after highly advanced HBPS. Methods: This single-institution retrospective study included 177 patients who developed severe postoperative complications (Clavien-Dindo classification≧grade3a) after highly advanced HBPS from 2010 to 2022 at Gifu University Hospital. We statistically analyzed pre-, intra-, and post-operative risks for FTR using logistic regression. Results: Nine postoperative mortalities occurred, for overall mortality rate of 1.3% (9 / 686) and FTR rate of 5.1% (9 /177). In univariate analysis, liver disease comorbidity, intra-operative blood loss, intra-operative blood transfusion, post-operative liver failure, post-operative respiratory failure, and post-operative bleeding were significantly correlated with FTR. A multivariate analysis revealed that intra-operative blood loss (>1600ml; odds ratio [OR] 77255486; 95% confidence interval [CI] 18.26–; p <0.0001) and post-operative respiratory failure (OR 43422062; 95% CI 9.83–; p <0.0005) were independently associated with FTR. Conclusions: FTR have been shown to be associated with hospital factors. This study showed that FTR may be also associated with peri-operative factors. Prevention of massive intra-operative blood loss and postoperative respiratory failure may be able to decrease FTR.