对于围手术期并发症导致的死亡，被定义为手术期并发症后的死亡率，这是一个在各种手术中研究的围手术期质量指标，但在外阴癌手术中尚未研究。本研究的目的是评估接受外阴癌手术治疗的患者的“未能拯救”情况。本次横断面研究调查了住院患者样本。研究人口为2001年1月至2015年9月期间接受外阴癌手术治疗的31,077名患者。主要结果指标有：（i）手术期住院期间发生的围手术期并发症（29个指标），以及（ii）在外阴手术中首次住院期间围手术期并发症后的死亡（未能拯救），采用多变量二元逻辑回归模型进行评估。人群的中位年龄是69岁，14,337名（46.1%）患者有医学共病。在外阴手术住院期间，有4736名（15.2%）患者报告了围手术期并发症。多变量分析显示，患者因素包括年龄较大、医学共病以及病态肥胖，以及治疗因素中的放射治疗和根治性外阴切除术与围手术期并发症相关（P < 0.05）。具有病态肥胖、更高的共病指数和先前的放射治疗的患者数量随时间推移而增加（P-trends < 0.001）。在4736名发生围手术期并发症的患者中，有55名患者在外阴手术住院期间死亡（未能拯救率为1.2%）。多变量分析显示，心脏骤停（调整后的概率比值[aOR]为27.25）、败血症或全身炎症综合征（aOR为11.54）、肺炎（aOR为6.03）、休克（aOR为4.37）和呼吸衰竭（aOR为3.10）与未能拯救（高风险病态）相关。高风险病态在一段时间内呈上升趋势，从2.0%上升至3.7%，但由高风险病态所导致的未能拯救率则从9.1%下降至2.8%（P-trend < 0.05）。接受外阴癌手术治疗的患者的共病率随时间增加，高风险并发症也在增加。然而，未能拯救率显著下降。版权所有©2023年Elsevier Inc.保留所有权利。

Failure-to-rescue, defined as mortality following a perioperative complication, is a perioperative quality indicator studied in various surgeries, but not in vulvar cancer surgery. The objective of this study was to assess failure-to-rescue in patients undergoing surgical therapy for vulvar cancer.This cross-section study queried the National Inpatient Sample. The study population was 31,077 patients who had surgical therapy for vulvar cancer from 1/2001-9/2015. The main outcomes were (i) perioperative morbidity (29 indicators) and (ii) mortality following a perioperative complication during the index admission for vulvar surgery (failure-to-rescue), assessed with a multivariable binary logistic regression model.The cohort-level median age was 69 years, and 14,337 (46.1%) had medical comorbidity. Perioperative complications were reported in 4736 (15.2%) patients during the hospital admission for vulvar surgery. In multivariable analysis, patient factors including older age, medical comorbidity, and morbid obesity, and treatment factors with prior radiotherapy and radical vulvectomy were associated with perioperative complications (P < 0.05). The number of patients with morbid obesity, higher comorbidity index, and prior radiotherapy increased over time (P-trends < 0.001). Among 4736 patients who developed perioperative complications, 55 patients died during the hospital admission for vulvar surgery (failure-to-rescue rate, 1.2%). In multivariable analysis, cardiac arrest (adjusted-odds ratio [aOR] 27.25), sepsis or systemic inflammatory response syndrome (aOR 11.54), pneumonia (aOR 6.03), shock (aOR 4.37), and respiratory failure (aOR 3.10) were associated with failure-to-rescue (high-risk morbidities). There was an increasing trend of high-risk morbidities from 2.0% to 3.7% over time, but the failure-to-rescue from high-risk morbidities decreased from 9.1% to 2.8% (P-trend < 0.05).Vulvar cancer patients undergoing surgical treatment had increased comorbidity over time with an increase in high-risk complications. However, failure-to-rescue rate has decreased significantly.Copyright © 2023 Elsevier Inc. All rights reserved.