Audit of emergency preoperative resuscitation

Abstract

A total of 148 patients of mean age 61 years with acute gastrointestinal disease who were assessed as requiring preoperative resuscitation were studied. Overall, the mortality rate was 14.2 per cent and the morbidity rate 50.7 per cent. Resuscitation was associated with a mean(s.e.m.) improvement in predicted mortality rate of 4.2(0.8) per cent and in morbidity rate of 4.3(0.7) per cent. However, there was a group of patients in whom resuscitation was unsuccessful, despite there being no apparent difference in duration or methods of resuscitation from those of the rest of the population studied. A poor response to resuscitation was found in 28 patients; this was commoner in the elderly (P < 0.001) and in women (P < 0.05). Complications were more frequent in patients failing to improve with resuscitation (P < 0.001). In the group deteriorating despite resuscitative (P < 0.001). In the a greater proportion of patients with a perforated viscus (P < 0.001), whereas intestinal obstruction was less common (P < 0.05). This study demonstrates that resuscitation can be audited and quantified. Preoperative resuscitation appears to be beneficial, but there is a group that may benefit from synchronous surgery and resuscitation.

Use of Recombinant Activated Factor VII (Novoseven) in Trauma and Surgery: Analysis of Outcomes Reported to an International Registry

“…No vari-(text continues on p. 35 ables achieved statistical significance on multivariate analysis, although a low increase in PT showed the strongest association with mortality (P = .052).…”

The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM)

“…There is room for further research into whether improving the physiology score by resuscitation improves overall outcome after operation. McIlroy et al 10 reported that preoperative resuscitation could improve physiology scores and that outcomes were poor in patients who failed to respond to resuscitation.…”

An analysis of the accuracy of P‐POSSUM scoring for mortality risk assessment after surgery for colorectal cancer

“…A 12 part acute physiology score which included the patient's age, cardiac and respiratory history, blood pressure, pulse rate, Glasgow Coma Score, haemoglobin, leucocyte count, serum electrolytes and urea, and details of the most recent electrocardiogram were obtained preoperatively. A six part operative severity score was obtained immediately after surgery including operative severity, number of procedures, total blood loss, the presence of peritoneal soiling, the presence and extent of malignancy, and the timing of surgery [1,12–16]. These data were entered by the operating surgeon on a standardized proforma and collected centrally by a data clerk.…”

“…The POSSUM (Physiological and Operative Severity Score for the Enumeration of Morbidity and Mortality) system has been proposed as one method of standardizing data so that direct comparisons of patient outcomes can be made despite different patterns of referral and population characteristics [12–16]. The system importantly takes into account operative severity as well as patient physiological characteristics when assessing risk.…”