Although it hasn’t been studied dynamically, surgical failure-to-rescue (FTR, death rate following complications) is a credible cross-sectional quality of care index. During the COVID-19 epidemic, researchers sought to investigate alterations in FTR following emergency surgery.

All adult patients undergoing general emergency surgery in 25 Spanish hospitals throughout the COVID-19 pandemic’s peak (March–April 2020), non–peak (May–June 2020), and 2019 control periods were included in the matched cohort analysis. A logistic regression model was used for a propensity score-matched comparison analysis, where the period was regressed on observed baseline attributes. A mixed-effects logistic regression model was subsequently built for each important variable. The primary factor was FTR. Post-operative complications, readmissions, reinterventions, and duration of stay were considered secondary factors.

A total of 5,003 patients were included (948 in the pandemic peak, 1,108 in the non-peak, and 2,947 in the control periods), with similar clinical traits, prognostic ratings, complications, reintervention, rehospitalization rates, and duration of stay across times. FTR was higher at the height of the pandemic compared to non-peak and pre-pandemic times (22.5% vs. 17.2% and 12.7%), and an adjusted analysis supported this difference (odds ratio [OR] 2.13, 95% 95% CI 1.27-3.66). In contrast to the pandemic non-peak period (median FTR change 0%, IQR -6.01-6.72%), when there was no discernible inter-hospital variability in FTR changes, there was some at the pandemic peak (median FTR change +8.77%, IQR 0- 29.17%). Higher COVID-19 incidence (OR 2.31, 95% CI 1.31–4.16) and various hospital features, such as tertiary level (OR 3.07, 95% CI 1.27-8.00), medium-volume (OR 2.79, 95% CI 1.14-7.34), and high basal-adjusted complication risk (OR 2.21, 95% CI 1.07-4.72), were linked to greater FTR rise.

The COVID-19 pandemic saw a variety of increases in FTR following emergency surgery, suggesting that it may function as a measure of a hospital’s adaptability. FTR monitoring might make it easier to identify centers with unique requirements during continuous healthcare issues.