Epidemiology of the high-risk population

Boehm, Olaf; Baumgarten, Georg; Hoeft, Andreas

doi:10.1097/mcc.0000000000000221

Cited by 25 publications

(8 citation statements)

References 55 publications

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“…Severe morbidity (sepsis, cardiac arrest, myocardial infarction or pneumonia) is most often noted within the first 30 days postoperatively [3], with increasing risk in conjunction with increasing pre-operative co-morbidity, as evidenced by a 30% risk in ASA III (American Society of Anaesthesiologists, physical status classification system), and about 50% in ASA IV patients [4,5], and particularly in the acute surgical setting [6]. These numbers correspond to the reported high postoperative in-hospital mortality, 8-9% after major upper abdominal surgery [7,8], again increased in case of co-morbidities such as chronic obstructive pulmonary disease [3]. This underlines the need for further improvements of perioperative care and especially in high risk patients ( Table 1).…”

Section: Introductionmentioning

confidence: 65%

Technological aided assessment of the acutely ill patient – The case of postoperative complications

Haahr-Raunkjær

Meyhoff

Sørensen

et al. 2017

European Journal of Internal Medicine

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Surgical interventions come with complications and highly reported mortality after major surgery. The mortality may be a result of delayed detection of severe complications due to lower monitoring frequency in the general wards. Several studies have shown that continuous monitoring is superior to the manually intermittent recorded monitoring in terms of detecting abnormal physiological signs. Hopefully improved observations may result in earlier detection and clinical intervention. This narrative review will describe current monitoring possibilities for postoperative patients and how it may prevent complications. Several wireless systems are being developed for monitoring vital parameters, but many of these are not yet validated for critically ill patients. The ultimate goal with patient monitoring and detect of events is to prevent postoperative complications, death and costs in the health care system. A few studies indicate that monitoring systems detect deteriorating patients earlier than the nurses, and this was associated with less clinical instability. An important caveat of future devices is to assess their effect in relevant patient populations and not only in healthy test-subjects. Implementation of novel technologies is expensive although expected to be cost-effective if just few adverse events can be prevented. The future is here with promising devices and the possibility to give an unprecedented precise risk estimation of adverse post-surgical events. Next step is to integrate existing evidence based treatment algorithms to demonstrate the clinical efficacy of implementing the new technology.

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Section: Introductionmentioning

confidence: 65%

Technological aided assessment of the acutely ill patient – The case of postoperative complications

Haahr-Raunkjær

Meyhoff

Sørensen

et al. 2017

European Journal of Internal Medicine

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“…2,3 Notably, when over-activated, inflammation can cause a series of severe clinical consequences, including sepsis, multiple organ dysfunction syndrome (MODS), and cancer recurrence, all of which can prove grave for patients. 4 Thus, clarification of the clinical regulatory mechanism of inflammation is urgently required.…”

Section: Introductionmentioning

confidence: 99%

The Relationship Between Circulating Bone Morphogenetic Protein-4 and Inflammation Cytokines in Patients Undergoing Thoracic Surgery: A Prospective Randomized Study

Zhao

Zhang

et al. 2021

JIR

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“…Given the effortlessness of relevant data collection, post-operative morbidity and mortality rates are used to compare surgeon and institution performance, with an improvement of provided service quality being the main objective [2,3] . These parameters have two basic disadvantages: the usual number of events is insufficient for statistical analysis [4] , and they directly correlate with the highly varying severity of cases handled in several institutions and by individual surgeons [5] . Their utilization, especially mortality as a measure of healthcare service quality, is strongly criticized [6,7] .…”

Section: Introductionmentioning

confidence: 99%

Correlation of Pre-Operative Co-Morbidity Indices with Peri-Operative and Post-Operative Metrics in Urological Patients Undergoing Major Open Procedures

Sarri

Fragkiadis

et al. 2019

J Anesth Surg

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Background:Individual surgeon and institutional performance are usually assessed by morbidity and mortality rates, which can be calculated using peri-operative metrics, such as POSSUM (Physiological and Operative Severity Score for the enUmeration of mortality and morbidity). Post-operative risk can be estimated using the surgical Apgar outcome score. However, pre-operative co-morbidity may contribute to case risk diversity and affect immediate peri-operative metrics and short- and long-term morbidity and mortality. We estimated the correlation between pre-operative co-morbidity or risk assessment indices and peri-operative metrics in urological patients. Material and Methods:The study included 100 consecutive patients (80.8% males, mean age ± SD 66.3 ± 10.7 years, range 30 - 88 years) undergoing major open urological procedures (39 nephrectomies, 43 radical prostatectomies, 18 radical cystectomies). Pre-operative co-morbidity was assessed using Charlson Comorbidity Index (CCI), age-adjusted CCI (AA-CCI), Cumulative Illness Rating Scale (CIRS), and Index of Co-Existent Diseases (ICED). Pre-operative risk was assessed with the American Society of Anesthesiologists index (ASA). Functional status was quantified based on estimation of the metabolic equivalent (MET). Peri-operative metrics included POSSUM and surgical Apgar scores. Results: All pre-operative indices significantly correlated with POSSUM, but none correlated with the surgical Apgar score. Conclusions:In patients undergoing major open urological procedures, risk stratification in the post-operative setting using the surgical Apgar score is independent of pre-operative co-morbidity status. In contrast, pre-operative co-morbidity and risk assessment correlated with peri-operative metrics used to calculate morbidity and mortality risk. Reports of death and complication rates do not take into account case diversity and, therefore, should be adjusted for co-morbidity status.

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Epidemiology of the high-risk population

Cited by 25 publications

References 55 publications

Technological aided assessment of the acutely ill patient – The case of postoperative complications

Technological aided assessment of the acutely ill patient – The case of postoperative complications

The Relationship Between Circulating Bone Morphogenetic Protein-4 and Inflammation Cytokines in Patients Undergoing Thoracic Surgery: A Prospective Randomized Study

Correlation of Pre-Operative Co-Morbidity Indices with Peri-Operative and Post-Operative Metrics in Urological Patients Undergoing Major Open Procedures

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