SynthesisBJS open2026
Hospital factors associated with failure to rescue after surgery: meta-analysis.
Synthesis in BJS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
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Authors and funding
6 authors.
Funding
Abstract
backgroundFailure to rescue (FTR) is a key driver of postoperative mortality and reflects a hospital's ability to recognize, escalate, and treat complications. Although FTR varies substantially between hospitals, the hospital characteristics that underpin this variation are inconsistently described. The aim of this study was to synthesize evidence on hospital-level factors associated with FTR after postoperative complications across surgical populations and health systems.
methodsA systematic review of observational studies evaluating associations between hospital-level characteristics and FTR in surgical patients was undertaken. MEDLINE, EMBASE, and Scopus were systematically searched on 17 July 2024 and updated to 31 December 2025. Hospital factors were classified into structural, staffing, and system domains. Where three or more non-overlapping studies reported adjusted estimates in comparable formats, random-effects meta-analyses were performed; otherwise, findings were summarized narratively. Methodological quality of included studies was assessed using the ROBINS-I tool (version 2).
resultsA total of 111 studies encompassing over 137 million patients and 301 hospital factors were included. Meta-analyses demonstrated lower FTR rates in larger hospitals (odds ratio 0.85, 95% confidence interval 0.74 to 0.97), hospitals with greater intensive care unit capacity (odds ratio 0.80, 0.71 to 0.90), and teaching hospitals (odds ratio 0.88, 0.83 to 0.93). Better nursing resources were consistently associated with lower FTR, including patient-to-nurse ratios (odds ratio 1.07, 1.03 to 1.10), higher nurse education (odds ratio 0.95, 0.91 to 0.99), and more favourable work environments (odds ratio 0.93, 0.90 to 0.95). Safety-net hospital status was associated with higher FTR (odds ratio 1.22, 1.03 to 1.45). Substantial heterogeneity was observed across most analyses.
conclusionHospital-level structural, staffing, and system characteristics are associated with variation in FTR. Postoperative mortality is closely linked to institutional capacity to detect and manage complications, underscoring the importance of adequate resourcing and system organization to improve surgical outcomes.
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