Association of number and type of serious complications with failure to rescue in children undergoing surgery: A NSQIP-Pediatric analysis

Soojin Kim*, Lauren Balmert, Mehul V. Raval, Emilie K. Johnson, Fizan Abdullah, David I. Chu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Failure to rescue (FTR) represents death after a serious complication. This study aims to determine the FTR rate in a pediatric surgical population, and if number (1 or 2 +) and type of serious complications are associated with FTR. Methods: A secondary analysis was performed using the National Surgical Quality Improvement Program Pediatric database from 2012 to 2016. Primary and secondary exposures of interest were number (1 or 2 +) and type of serious complications, respectively. Propensity score analysis adjusted for baseline covariates. Primary outcome was FTR. Results: Of 36,167 children with ≥ 1 serious complication, there were 851 deaths resulting in a FTR rate of 2.4%. Having 2 + serious complications was associated with higher adjusted odds of FTR (OR 1.77, 95% CI 1.52–2.08, p < 0.0001). Among those who had one complication, the type of serious complication was significantly associated with FTR. When type of initial serious complication was adjusted, number of serious complications continued to be strongly associated with FTR (OR 2.00, 95% CI 1.67–2.38, p < 0.0001). Conclusions: FTR rate within a large, diverse, multi-specialty pediatric surgical population was 2.4%. Both number and type of postoperative complications were associated with FTR. These findings may facilitate early recognition of high-risk patients and identify quality targets for pediatric surgical centers. Level of Evidence: Retrospective study (secondary analysis), Level II.

Original languageEnglish (US)
Pages (from-to)2584-2590
Number of pages7
JournalJournal of pediatric surgery
Issue number12
StatePublished - Dec 2020


  • American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P)
  • Failure to rescue (FTR)
  • Mortality
  • Pediatric surgery
  • Post-operative complications

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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