Failure to Rescue in the Geriatric Surgical Population: A Literature Review

Purpose of Review Older surgical patients present with unique attributes that can ultimately influence post-operative outcomes, including rates of failure to rescue (FTR), defined as the proportion of patients experiencing complications that ultimately die. This paper aims to review the recent literature with regards to FTR specific to the geriatric surgical population. Recent Findings There are independent predictors of FTR in the geriatric surgical population including frailty, comorbidities, and do-not-resucutiate (DNR) status. FTR rates in the geriatric population have been studied in a variety of surgical specialties and operative approaches. Hospital characterisitics such as volume and provider expertise influence FTR rates in older adults, and FTR rates can have significant impact on hospitalization costs. Several different risk stratification tools, including the Modified Frailty Index (mFI-5) and Geriatric Rescue After Surgery (GRAS) score, have been used to identify older patients with high risk of FTR events. Summary Older age is an independent risk factor for FTR. It is imperative that surgeons understand risk factors for FTR in the geriatric surgical population and consider the use of relevant risk stratification tools to help inform perioperative decisions. In order to ultimately reduce the risk of FTR for the geriatric patient, hospital-led initiatives should involve implementation of guideline-specific care as well as appropriate use of ancillary services specialized in the care of geriatric surgical patients.