Failure-to-rescue following major surgical complications in gynecologic oncology: A National Inpatient analysis.

Abstract

e23124 Background: Postoperative complications are common after major gynecologic oncology surgery, yet mortality is not inevitable. Failure-to-rescue (FTR), defined as death after a treatable complication, reflects hospital capacity to recognize and manage deterioration, but national benchmarks in gynecologic oncology are limited. Methods: We performed a retrospective, survey-weighted analysis of the U.S. National Inpatient Sample (NIS), 2016 to 2023. Adult hospitalizations (age 18 years or older) with gynecologic malignancy (ICD-10-CM C51 to C58) undergoing major gynecologic surgery (ICD-10-PCS female reproductive system procedures) were included. Encounters with palliative care coding (Z51.5) were excluded. Major postoperative complications were identified using ICD-10 diagnosis and procedure codes and included sepsis or septic shock, hemorrhage or transfusion-requiring bleeding, venous thromboembolism, acute kidney injury, and bowel injury or peritonitis. The primary outcome was FTR, defined as in-hospital death among admissions with one or more major complications. Secondary outcomes included overall mortality, ICU escalation proxy (mechanical ventilation or shock), length of stay (LOS), cost, and discharge disposition. Results: Among 65,669 gynecologic oncology surgical admissions, 33.27% experienced one or more major postoperative complications (95% CI 32.77 to 33.77). The most frequent complications were bleeding (25.38%, 95% CI 24.89 to 25.88) and acute kidney injury (9.53%, 95% CI 9.27 to 9.78). Overall in-hospital mortality was 0.36% (95% CI 0.32 to 0.41). Among complication cases, mortality was 1.01% (95% CI 0.88 to 1.16), representing the FTR rate in the complication subgroup. ICU escalation among complication cases occurred in 5.68% (95% CI 5.36 to 5.99), including mechanical ventilation in 3.01% (95% CI 2.78 to 3.25) and shock in 3.33% (95% CI 3.08 to 3.57). Complications were associated with higher resource use, with mean LOS 7.47 days versus 3.14 days without complications, and mean cost $34,746.72 (95% CI $33,613.31 to $35,880.14) versus $20,442.15 (95% CI $19,836.75 to $21,047.55). Complications were also associated with higher rates of non-home discharge. Conclusions: In a national sample of gynecologic oncology surgery hospitalizations, one-third experienced major postoperative complications, while mortality among complication cases was approximately 1%. Complications were associated with substantially higher ICU escalation, LOS, cost, and non-home discharge. These findings provide national benchmarks for complication burden and failure-to-rescue in gynecologic oncology and support FTR as a practical quality metric for surgical oncology improvement efforts.