Understanding Failure to Rescue in Geriatric Trauma: A National Analysis of Predictors and Outcomes.

Background: Failure to rescue (FTR), defined as mortality following major complications, has become a critical quality metric across medical specialties.

Objective: This study aimed to evaluate temporal trends, predictors, and disparities in FTR among geriatric trauma patients using a national trauma database.

Methods: A retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Improvement Program dataset (2017-2021). Patients aged 65 years and older with major complications were included. FTR was defined as in-hospital mortality following complications. Demographic and clinical variables, including Injury Severity Score (ISS), Modified Frailty Index (mFI), and insurance status, were analyzed. Trauma center level and temporal trends in FTR rates were also assessed.

Results: Among 13,744 patients with major complications, the overall FTR rate was 44.5%, with rates increasing annually from 41.8% in 2017 to 47.2% in 2021 ( p < .001). Older age, higher ISS, and treatment at Level II and III trauma centers were significant predictors of FTR. Disparities in FTR were observed, with Asian, Black, and Hispanic patients demonstrating higher odds of FTR compared to their respective counterparts, as well as patients covered by public insurance (Medicaid and Medicare). mFI was not significantly associated with FTR.

Conclusion: Findings showed a significant increase in FTR rates over time among geriatric trauma patients, with findings highlighting disparities such as race and insurance status associated with FTR, as well as predictors such as age, injury severity, and trauma verification level. Increasing access to high-level trauma centers, enhancing resource allocation, and refining care protocols are critical to mitigating FTR risk in this vulnerable population.