Systematic review of Failure-to-rescue publications highlights gaps in evidence and standardizationMost surgery studies track failure-to-rescue but ignore how to fix it

Frontiers in Medicine Published May 24, 2026 DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider that Failure-to-rescue research is geographically concentrated and lacks standardization, limiting its use as a quality metric.

This is a systematic review of 38 studies on Failure-to-rescue (FTR) in surgical patients, with a median sample size of 29,482 patients across included studies. The review focused on temporal trends, how FTR is used as an outcome, and its operationalization as a hospital structure, process, or clinical outcome. Key findings show 71% of studies used FTR as a primary outcome. FTR was operationalized as a hospital structure in 44.8% of studies, as a process in 28.9%, and as a clinical outcome in 26.3%. Abdominal surgery and related subspecialties represented 58% of publications, while emergency surgery and trauma represented 18.4%. Bibliometric analysis found a mean of 18.4 Scopus citations and 23.2 Google Scholar citations per study, with 76% published in first-quartile surgical journals and a mean impact factor of 6.2. No significant differences were found in bibliometric metrics across indicator categories (p > 0.60) or surgical subspecialties (p > 0.62). The review acknowledges limitations, including a limited volume of high-quality clinical surgical studies, geographic concentration (USA: 47.4%, Europe: 42.1%), subspecialty skew, and a predominance of retrospective North American and European studies in abdominal and emergency surgery. Practice relevance is restrained, emphasizing that standardization of FTR definitions, expansion to low- and middle-income countries, broader subspecialty engagement, and prospective interventional studies are needed to advance FTR from a surveillance metric to an actionable quality-improvement tool.

Doctors in high-income countries like the USA and Europe are studying a specific problem called failure-to-rescue. This happens when a patient survives the initial surgery but dies later because the hospital could not save them. A recent look at 38 studies found that researchers are mostly watching this problem happen rather than fixing it. The review looked at data from a median of 29,482 patients across these studies. Most of the work came from abdominal surgery and emergency trauma teams. Seventy-one percent of the studies used failure-to-rescue as a main topic. However, only 44.8 percent treated it as a sign of hospital structure, 28.9 percent as a process, and 26.3 percent as a clinical outcome. These numbers show a heavy focus on watching the problem instead of solving it. The studies mostly came from North America and Europe, which limits how well the findings apply elsewhere. The research also relied heavily on past data rather than looking forward to prevent deaths. This imbalance means we have good surveillance but lack actionable tools for quality improvement. We need to expand these efforts to include low- and middle-income countries and involve more surgical specialties. Without these changes, failure-to-rescue will remain a metric for counting deaths rather than a tool for saving lives.

What this means for you:

We track failure-to-rescue well but lack tools to use it for improving care.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

View Original Abstract ↓

BackgroundFailure to rescue (FTR)—the inability to prevent mortality following a complication—is a critical quality and safety metric reflecting a healthcare system's capacity to recognize and respond to patient deterioration. Despite its conceptual prominence, the actual use of FTR in surgical research remains poorly characterized. This systematic review addresses the gap by examining how FTR has been operationalized in recent clinical surgical studies, which subspecialties and regions contribute to the evidence base, and what bibliometric patterns reveal about knowledge uptake.MethodsA systematic literature search was conducted following PRISMA guidelines for clinical studies on FTR published between 2019 and 2024. PubMed and PubMed Central were searched using structured queries. Studies were assessed for risk of bias using the Newcastle-Ottawa Scale. Primary outcomes were: (1) temporal trends in FTR publications, (2) FTR's use as primary or secondary outcome, and (3) its operationalization as an indicator of structure, process, or clinical outcome according to Donabedian's framework. Secondary outcomes included geographic distribution of contributing authors, surgical subspecialty representation, and bibliometric impact (Scopus and Google Scholar citations, Altmetric scores).ResultsOf 322 articles screened, 38 met inclusion criteria. The literature consisted predominantly of multicenter retrospective studies (median sample size 29,482 patients), with FTR serving as the primary outcome in 71% of studies. FTR was most frequently operationalized to assess hospital structure (44.8%), followed by process (28.9%) and clinical outcome (26.3%). Publication output showed moderate growth from 2019 to 2021 (9–11 manuscripts/year) but declined thereafter. High-income countries dominated contributions, with the USA accounting for 47.4% of studies and Europe for 42.1%. Abdominal surgery and related subspecialties (emergency, hepatobiliary, colorectal) represented 58% of publications; emergency surgery and trauma contributed 18.4%. Despite recent publication dates, studies achieved substantial bibliometric impact: mean citations were 18.4 (Scopus) and 23.2 (Google Scholar), with 76% published in first-quartile surgical journals (mean impact factor 6.2). No significant differences in bibliometric metrics were observed across indicator categories (structure/process/outcome; p > 0.60) or surgical subspecialties (p > 0.62), suggesting a homogeneous field in terms of impact regardless of application.ConclusionsDespite growing recognition of FTR as a quality metric, the volume of high-quality clinical surgical studies remains limited, geographically concentrated, and subspecialty-skewed. The field is characterized by high impact but narrow scope: predominantly retrospective North American and European studies in abdominal and emergency surgery. Standardization of FTR definitions, expansion to low- and middle-income countries, broader subspecialty engagement, and prospective interventional studies are urgently needed to advance FTR from a surveillance metric to an actionable quality-improvement tool. The field must transition FTR from a passive monitoring metric to an active driver of quality improvement to realize its potential to save lives and reduce preventable postoperative mortality.Systematic Review RegistrationINPLASY, identifier 202630097.

Systematic review of Failure-to-rescue publications highlights gaps in evidence and standardizationMost surgery studies track failure-to-rescue but ignore how to fix it

Study Details

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Systematic review of Failure-to-rescue publications highlights gaps in evidence and standardizationMost surgery studies track failure-to-rescue but ignore how to fix it

Study Details

Low-intensity pulsed ultrasound shows a 0.79 healing rate in nonunion fractures across observational studies

Trial results show mixed success for ultrasound on nonunion fractures

Clinical research that matters. Delivered to your inbox.

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