The "Failure to Rescue" metric as an indicator of the quality of the healthcare system organization in pancreatoduodenectomy

Pancreatoduodenectomy (PD) is characterized by a high rate of complications and mortality. The Failure to Rescue (FTR) metric, defined as mortality following major complications, is recognized as a key indicator of surgical care quality, since inter-­hospital differences in outcomes are determined by the ability to "rescue" the patient rather than by the complication rate. Purpose of the study . To analyze current scientific data concerning the FTR metric as a marker of care quality in pancreatoduodenectomy. Materials and methods . A literature search was conducted in the PubMed/MEDLINE, Web of Science, Scopus, and Cochrane Library databases for publications from 2000 to 2025 using the following keywords: “failure to rescue,” “pancreatoduodenectomy,” “pancreatic surgery,” “postoperative complications,” “mortality,” and “quality of care.” Eligible publications included original studies (cohort studies, case–control studies, and randomized controlled trials), systematic reviews, and meta-analyses meeting the following criteria: assessment of the failure-to-rescue (FTR) metric in patients undergoing pancreatoduodenectomy; a sample size of at least 100 patients; and a clear definition of postoperative complications and mortality. Results . The FTR rate ranges from 4 to 41 %, depending on methodology and geographic region. Key risk factors include: age ≥ 65 years, rating on the scale of the American Society of Anesthesiologists (ASA) class ≥ 3, sarcopenic obesity, hypoalbuminemia, renal failure, shock, pancreatic fistula, and accumulation of complications. Systemic factors include low hospital surgical volume, staff shortages, and lack of 24/7 access to interventional radiology. Implementation of the PORSCH algorithm (Postoperative Standardization of Care: the Implementation of Best Practice After Pancreatic Resection) reduced 90‑day mortality from 5 to 3 % (OR 0.42). Centralization of surgery in high-volume centers, ERAS (Enhanced Recovery After Surgery) protocols, and early warning systems EWS (Early Warning Systems) significantly reduce FTR. Conclusion . FTR is a critical quality indicator in PD. Its reduction is achieved through systemic measures: centralization of care, algorithm-based management, and ensuring access to interventional radiology. Standardization of the FTR is necessary for data comparability