Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

Trangbæk, Rune Munch; Burcharth, Jakob; Gögenür, Ismail

doi:10.1007/s00268-022-06763-y

Cited by 5 publications

(4 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Gastrointestinal tract (GI) perforation, bowel ischemia, and bowel obstruction are considered acute high‐risk abdominal (AHA) disorders, often requiring emergency surgery 1 . Due to the high risk of postoperative complications and death after AHA surgery, standardized multidisciplinary perioperative protocols have been implemented 2–5 . These specialist‐led care AHA regimens seem to reduce complication and mortality rates 2 …”

Section: Introductionmentioning

confidence: 99%

“…1 Due to the high risk of postoperative complications and death after AHA surgery, standardized multidisciplinary perioperative protocols have been implemented. [2][3][4][5] These specialist-led care AHA regimens seem to reduce complication and mortality rates. 2 Myocardial injury after noncardiac surgery (MINS) is a frequent but often unrecognized postoperative complication.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association between troponin I levels and mortality among patients undergoing acute high‐risk abdominal surgery—A cohort study

Kanstrup,

Serup,

Svarre

et al. 2024

World j. surg.

View full text Add to dashboard Cite

BackgroundMyocardial injury after noncardiac surgery (MINS) is associated with 30‐day mortality in heterogeneous surgical populations but is barely described after acute high‐risk abdominal surgery. The impact of dynamic changes has not previously been investigated. The objectives were to determine the incidence of MINS in this population, the association between mortality and MINS, and whether plasma troponin I (TnI) dynamics have any impact on mortality.MethodsA prospective cohort study of 341 patients undergoing acute high‐risk gastrointestinal surgery was conducted. Plasma TnI was measured at the first four postoperative days. MINS was defined as any increased TnI level >59 ng/L. TnI dynamic required either two succeeding measurements of TnI >59 ng/L with a >20% increase/fall or one measurement of TnI >59 ng/L with a succeeding measurement of TnI <59 ng/L with a >50% decrease. Adjusted mortality rates were calculated using inverse probability of treatment weighting and competing risk analyses.ResultsThe incidence of MINS was 23.8% and dynamic TnI changes occurred in 15.6% of the patients. The unadjusted 30‐day and 1‐year mortality were 19.8% and 35.9% in patients with MINS, compared with 2.7% and 11.6%, respectively, in patients without MINS (p < 0.001). After adjusting, the differences remained significant. There was no difference in mortality between patients with or without dynamic changes in TnI level.ConclusionMINS occurred frequently and was associated with increased mortality. TnI monitoring might help identify patients with increased risk of mortality and improve care. Research on preventive measures and treatments is warranted.Trial Registration Number and AgencyClinicalTrials.gov Identifier: NCT05933837, retrospective registered.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between troponin I levels and mortality among patients undergoing acute high‐risk abdominal surgery—A cohort study

Kanstrup,

Serup,

Svarre

et al. 2024

World j. surg.

View full text Add to dashboard Cite

show abstract

“…Treatment of disorders such as gastrointestinal tract (GI) perforation, ischemia, and obstruction often requires acute high-risk abdominal (AHA) surgery, which is associated with a high risk of severe postoperative complications and death. Standardised specialist-led, multidisciplinary perioperative treatment protocols [1][2][3] have been implemented to improve surgical outcomes. [1][2][3][4] Despite these protocols, the risk of severe complications such as myocardial injury after non-cardiac surgery (MINS) remains high.…”

Section: Introductionmentioning

confidence: 99%

“…Standardised specialist-led, multidisciplinary perioperative treatment protocols [1][2][3] have been implemented to improve surgical outcomes. [1][2][3][4] Despite these protocols, the risk of severe complications such as myocardial injury after non-cardiac surgery (MINS) remains high. [5][6][7] MINS is defined as one or more postoperative cardiac troponin I (TnI) or troponin T concentrations exceeding the 99th percentile of the upper reference limit of the assay within 30 days after surgery and is likely due to ischemia.…”

Section: Introductionmentioning

confidence: 99%

The effects of troponin screening among patients undergoing acute high‐risk abdominal surgery: A retrospective cohort study

Kanstrup,

Svarre,

Rasmussen

et al. 2024

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

BackgroundAcute high‐risk abdominal (AHA) surgery is associated with a high short‐term mortality rate. This might be partly attributed to myocardial injury after non‐cardiac surgery (MINS) defined by elevated postoperative troponin levels. The myocardial injury is often asymptomatic; thus, troponin screening seems to be the best diagnostic method.We aimed to assess whether implementing troponin screening with subsequent individualised interventions as standard care is associated with reduced mortality after AHA surgery. We also explored the treatment implications in the screening period.MethodsA retrospective cohort of 558 patients undergoing surgery from February 2018 to March 2021 was included. The patients undergoing surgery before March 2019 served as the historical control group, while the screening group consisted of patients undergoing surgery from March 1, 2019. Troponin I was to be measured 6–12 h postoperatively and in the morning of the succeeding 4 days. Patients with myocardial injury were assessed, and treatment was individualised after multiple disciplinary consultations. The primary outcome was the unadjusted 30‐day mortality rates. Inverse probability treatment weighting was used to adjust for selection bias.ResultsWe included 558 patients: 382 in the screening group and 176 in the historical control group. In the screening group, 15 patients (3.9%) died before the first blood sampling, and in 31 patients (8.1%), troponin screening was omitted, leaving only 336 patients screened. Myocardial injury was diagnosed in 81 patients (24.1%) of the 336 patients. Of these, 59 (72.8%) had a cardiac consultation. No interventions or alterations in relation to myocardial injury were done in 67 patients (82.7%).The 30‐day mortality was 13.8% (95% CI 8.7%–18.9%) in the control group and 11.1% (95% CI 8.0%–14.3%) in the screening group. The absolute risk difference was −2.7% (95% CI −8.7%–3.3%; p = .38), which was unchanged after adjustment. The difference remained unchanged after 90 days and 1 year.ConclusionThe implementation of postoperative troponin screening was not associated with reduced mortality after AHA surgery. Research on the prevention and treatment of MINS is warranted before the implementation of standard troponin screening.

show abstract

Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis

McKechnie,

Tessier,

Archer

et al. 2023

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Implementing Bundle Care in Major Abdominal Emergency Surgery: Long‐Term Mortality and Comprehensive Complication Index

Cited by 5 publications

References 40 publications

Association between troponin I levels and mortality among patients undergoing acute high‐risk abdominal surgery—A cohort study

Association between troponin I levels and mortality among patients undergoing acute high‐risk abdominal surgery—A cohort study

The effects of troponin screening among patients undergoing acute high‐risk abdominal surgery: A retrospective cohort study

Enhanced recovery after surgery protocols following emergency intra-abdominal surgery: a systematic review and meta-analysis

Contact Info

Product

Resources

About