Factors associated with failure to rescue after liver resection and impact on hospital variation: a nationwide population-based study

Arthur K E Elfrink*, Pim B Olthof, Dutch Hepato Biliary Audit Group, Rutger-Jan Swijnenburg, Marcel den Dulk, Marieke T de Boer, J Sven D Mieog, Jeroen Hagendoorn, Geert Kazemier, Peter B van den Boezem, Arjen M Rijken, Mike S L Liem, Wouter K G Leclercq, Koert F D Kuhlmann, Hendrik A Marsman, Jan N M Ijzermans, Peter van Duijvendijk, Joris I Erdmann, Niels F M Kok, Dirk J GrünhagenJoost M Klaase

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)


Background: Failure to rescue (FTR) is defined as postoperative complications leading to mortality. This nationwide study aimed to assess factors associated with FTR and hospital variation in FTR after liver surgery. Methods: All patients who underwent liver resection between 2014 and 2017 in the Netherlands were included. FTR was defined as in-hospital or 30-day mortality after complications Dindo grade ≥3a. Variables associated with FTR and nationwide hospital variation were assessed using multivariable logistic regression. Results: Of 4961 patients included, 3707 (74.4%) underwent liver resection for colorectal liver metastases, 379 (7.6%) for other metastases, 526 (10.6%) for hepatocellular carcinoma and 349 (7.0%) for biliary cancer. Thirty-day major morbidity was 11.5%. Overall mortality was 2.3%. FTR was 19.1%. Age 65–80 (aOR: 2.86, CI:1.01–12.0, p = 0.049), ASA 3+ (aOR:2.59, CI: 1.66–4.02, p < 0.001), liver cirrhosis (aOR:4.15, CI:1.81–9.22, p < 0.001), biliary cancer (aOR:3.47, CI: 1.73–6.96, p < 0.001), and major resection (aOR:6.46, CI: 3.91–10.9, p < 0.001) were associated with FTR. Postoperative liver failure (aOR: 26.9, CI: 14.6–51.2, p < 0.001), cardiac (aOR: 2.62, CI: 1.27–5.29, p = 0.008) and thromboembolic complications (aOR: 2.49, CI: 1.16–5.22, p = 0.017) were associated with FTR. After case-mix correction, no hospital variation in FTR was observed. Conclusion: FTR is influenced by patient demographics, disease and procedural burden. Prevention of postoperative liver failure, cardiac and thromboembolic complications could decrease FTR.

Original languageEnglish
Pages (from-to)1837-1848
Number of pages12
Issue number12
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
The authors would like to thank all surgeons, interventional radiologists and administrative nurses for data registration in the DHBA database, as well as the Dutch Hepato Biliary Audit Group for scientific input.

Publisher Copyright:
© 2021


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