Systemic causes are important risk factors for failure after unscheduled colorectal revision surgery.

Background: The rates of unscheduled revision surgery (URS) after colorectal surgery and failure to rescue-surgical (FTR-s) are 2.4% and 11–17% respectively. The aim of this study was to evaluate the causes of URS lethality to reduce this rate after colorectal surgery. Methods: From 2011 to 2021, 337 surgeons collected 547 URS. Type of procedure, time course, diagnostic and detection means, time to decision, time to complication(s), causes of URS, delay of URS, and death were recorded and allowed for multivariate systemic analysis of risk factors for death (FTR-s) after URS. Systemic causes of delay were analyzed as assessment of urgency, communication, skills, organization of the operative program, and transport. Results: The two main causes of URS were infectious (66% of which 50% by fistula or anastomotic release) and vascular (18%). The rate of FTRs was 10%. The systemic causes rate of FTR-s were 35%. The FTRs were related to the patient (ASA score 3–4: RR: 6 [1–40]; age: RR: 1.05 [1–1.1]), to the surgical procedure (laparotomy: RR: 4.5 [1.6–12]) and to the systemic causes responsible for the delay in the realization of URS (RR: 4.1 [1.4–12]). Conclusion: By avoiding systemic causes, more than one third of the deaths from FTR-s after colorectal surgery could be avoided. [ABSTRACT FROM AUTHOR]