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"Failure to Rescue" as a Novel Quality Metric in Pediatric Liver Transplantation.

“Failure to rescue” (FTR) is defined as the death of a patient after a treatable complication. It was first introduced in 1992 by Silber et alwho compared outcomes after 2 standard surgical procedures, cholecystectomy and transurethral resection of prostate, across hospitals and reported that the risk of death after a complication dependedmore on hospital related factors than patient factors. Failure to rescue is now a standard metric of the quality of health care in evaluating hospitals, nursing care, and surgical units. It is considered a reliable measure of the quality of perioperative care, monitoring protocols, early identification of complications, effective intrateam communication, and institution of remedial measures. FTR has not been extensively used in transplantation as a quality metric, though intuitively, organ transplantation teams need all the above noted factors for successful delivery of care. In this issue, Cramm et al have for the first time evaluated FTR as a quality metric in pediatric liver transplantation (PLT). They analyzed data from21US centers andover 2000 PLTavailable from the Studies of Pediatric Liver Transplantation. The authors compared the complication rates and their impact on FTR mortality and FTRdeath-censored graft loss rates in three 90-day mortality and 90-day death-censored graft loss tertiles. They reported that although centers in the high-mortality tertile had higher complication rates, the FTR mortality rate was much higher than the low-mortality tertile. The authors conclude that FTR can play a role as a quality improvement tool in transplantation. They also recommend expansion of data sets in currently used databases to enable routine comparison of FTR among centers carrying out liver transplantation. Is FTR a good-quality measure for PLT? Does it have the sensitivity to identify better-performing programs when there