Failure-to-rescue after major complications in endometrial cancer: A National Inpatient analysis (NIS, 2016–2023).

Abstract

e17637 Background: Although endometrial cancer is often considered low risk, postoperative outcomes may be driven more by hospital rescue capacity than tumor biology. Failure-to-rescue (FTR), defined as death after a major complication, is a key surgical quality metric that remains poorly characterized nationally in gynecologic oncology. This study examines the burden, drivers, and system-level variation in FTR after surgery for endometrial cancer. Methods: A retrospective, survey-weighted analysis of the National Inpatient Sample (2016–2023) was performed. Adult hospitalizations with uterine or endometrial cancer (ICD-10-CM C54–C55) undergoing hysterectomy (ICD-10-PCS 0UT*) were identified, excluding admissions with metastatic disease or palliative care coding. Major complications were defined as sepsis (A40/A41, R65.20/R65.21), shock (R57*), acute kidney injury (N17*), respiratory failure (J96*), or invasive mechanical ventilation (5A1935Z/5A1945Z/5A1955Z). FTR was defined as in-hospital death among hospitalizations with major complications. Survey-weighted analyses and multivariable logistic regression evaluated associations with mortality and FTR, adjusting for demographics, payer, socioeconomic status, hospital characteristics, year, and complication type. Results: The weighted cohort included 96,675 hysterectomy hospitalizations for endometrial cancer nationally. Major postoperative complications occurred in 9.9% of admissions, while overall in-hospital mortality was low (0.22%). Mortality was highly concentrated among patients with major complications, yielding a failure-to-rescue (FTR) rate of 1.83%. The most common complications were acute kidney injury (7.2%), respiratory failure (2.8%), sepsis (1.4%), invasive mechanical ventilation (1.0%), and shock (0.8%). Admissions complicated by major events were associated with substantially greater inpatient utilization, with mean length of stay increasing from 3.3 to 8.4 days. In adjusted analyses restricted to patients with major complications, in-hospital mortality increased with age (adjusted odds ratio [aOR] 1.10 per year, 95% CI 1.04–1.16) and was strongly associated with severe organ failure, including invasive mechanical ventilation (aOR 14.03, 95% CI 2.34–84.26), shock (aOR 9.41, 95% CI 1.87–47.28), sepsis (aOR 8.78, 95% CI 2.61–29.48), and respiratory failure (aOR 8.68, 95% CI 1.55–48.59). Conclusions: Among patients undergoing hysterectomy for endometrial cancer, postoperative mortality is rare but largely attributable to failure-to-rescue after major complications. Variation in FTR by complication severity and hospital characteristics underscores rescue capacity, rather than baseline risk, as the primary driver of outcomes.