Determinants of Failure to Rescue After Pulmonary Resection for Lung Cancer: Insights From a National Inpatient Sample.

BACKGROUND AND OBJECTIVES: Failure to rescue (FTR), defined as death following a postoperative complication, is an established quality metric; however, national data after pulmonary resection remain limited. We aim to identify patient-, procedural-, and hospital-level factors associated with FTR after pulmonary resection for lung cancer and evaluate related outcomes. METHODS: The National Inpatient Sample (2016-2022) was used to identify adults undergoing elective pulmonary resection for lung cancer who developed ≥ 1 major complication. FTR was defined as in-hospital mortality. Multivariable logistic regression identified predictors. Secondary outcomes included length of stay, costs, and discharge disposition. RESULTS: Among 14,575 patients with major complications, FTR occurred in 2.6%. Frailty (OR 3.44, 95% CI 2.73-4.35) and comorbidity burden (Elixhauser ≥ 2: OR 4.87, 1.54-15.43) were the strongest predictors. Pneumonectomy (OR 2.78, 1.82-4.23), age ≥ 75 years (OR 2.21, 1.47-3.32), and open approach (OR 1.78, 1.41-2.24) were also associated, while female sex and private insurance were protective. No hospital factors were independently associated. CONCLUSIONS: FTR is driven by patient vulnerability and procedural complexity rather than hospital characteristics. These findings emphasize preoperative risk stratification and complication management in high-risk patients but do not support regionalization to high-volume centers as a strategy to reduce FTR.