Medical emergency team activation in patients pre- and post-liver transplantation is associated with prolonged length of stay and higher morbidity

Robertson, M.; Chung, Woo-Suk; Huynh, Andrew; O'Halloran, Tessa; Warrillow, Stephen; Gow, Paul J; Angus, Peter W; Jones, Daryl Rhys

doi:10.1016/s0168-8278(17)30668-2

Cited by 4 publications

(6 citation statements)

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“…Almost all patients had received intraoperative vasopressor support, and 58% had a documented intraoperative hypotensive event. Of those patients who were hypotensive, the median number of hypotensive episodes was 3.5 (1)(2)(3)(4)(5)(6)(7)(8)(9). A detailed overview is presented in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…The composition of an RRT can include critical care physicians, anesthetists, critical care nurses, and respiratory therapists (2). Major surgery poses a signi cant physiological challenge to patients, which in turn can predispose them to an increased risk of postoperative deterioration (3,4). Past case-control and cross-sectional studies have implicated an array of preoperative and anesthetic factors that may be associated with postoperative patient deterioration and the need for RRT activation (5-7).…”

Section: Introductionmentioning

confidence: 99%

“…Postoperatively, in the PACU, 10% of patients had received vasopressor support, and 45% of patients had a documented hypotensive episode; the median number of hypotensive epochs was 2(1)(2)(3)(4). An overview of hypotension and vasopressor use in PACU is presented in Table3.…”

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confidence: 99%

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Rapid Response Team activation after major hip surgery: patient characteristics and outcomes

Pritchard

Jones

Bellomo

et al. 2020

Preprint

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Background: Rapid response teams (RRTs) are a critical care resource that review deteriorating patients within the hospital. We aimed to describe demographic, preoperative, surgical, anesthetic, and postoperative characteristics of patients who required RRT activation after major hip surgery. We also sought to assess whether these characteristics where associated with mortality during the index hospital admission.Methods: We reviewed an RRT database of adult patients undergoing orthopedic surgery at a university teaching hospital. We then retrospectively reviewed the medical records to extract a priori–defined patient, preoperative, surgical, anesthetic, and postoperative data of major hip surgery admissions between September 2014 and December 2017. Patients who survived the index hospital stay were compared to those who died.Results: Overall, 187 patients had postoperative RRT activations. Median (interquartile range) age was 84.0 (78-90) years; 125 (67%) were female, and most patients had at least one significant comorbidity, median Charlson Comorbidity Index (CCI) 5.0 (4.0-7.0). The majority of patients were frail (68%), American Society of Anesthesiologists physical status Class 3 or greater (91%), and underwent nonelective surgery (88%). Median (interquartile range) time from surgery to RRT activation was 29.4 (11.3–75.0) hours, and 25 (13%) patients had unplanned admissions to intensive care or high dependency units. Compared to patients who survived RRT activation, those who died displayed higher mean CCI (6.5 [1.8] vs. 5.5 [2.1], p = 0.02), were more frail (80.1% vs. 56.5%, OR = 3.2, 95% CI: 1.2,8.1; p = 0.03), and received less intraoperative opioids (intravenous morphine equi-analgesia: median = 5.8 (0.1–8.20 vs. 11.7 (3.7–19.0) mg, p = 0.03). They were also more likely to have received an urgent medical review prior to RRT activation (62% vs. 40%, OR = 2.4, 95% CI: 1.1, 5.6); p = 0.05.Conclusions: Death after RRT activation occurred in 1 in 7 patients undergoing major hip surgery. Common patient characteristics included advanced age (> 82 years), frailty, high CCI, and emergency surgery. Further studies investigating perioperative surveillance teams in the identification of the high-risk patients before surgery and deteriorating patients after major hip surgery are warranted.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rapid Response Team activation after major hip surgery: patient characteristics and outcomes

Pritchard

Jones

Bellomo

et al. 2020

Preprint

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“…The composition of an RRT can include critical care physicians, anesthetists, critical care nurses, and respiratory therapists [2] . Major surgery poses a significant physiological challenge to patients, which in turn can predispose them to an increased risk of postoperative deterioration [3] , [4] . Past case–control and cross-sectional studies have implicated an array of preoperative and anesthetic factors that may be associated with postoperative patient deterioration and the need for RRT activation [5] , [6] , [7] .…”

Section: Introductionmentioning

confidence: 99%

Rapid response team activation after major hip surgery: A case series

Weinberg

Pritchard

Louis

et al. 2022

International Journal of Surgery Case Reports

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Introduction We describe the demographic, preoperative, surgical, anesthetic, and postoperative characteristics of patients who required a rapid response team (RRT) activation after major hip surgery. We determined the characteristics and outcomes of patients that require RRTs after major hip surgery, and their associations with mortality. Presentation of cases We retrospectively reviewed adult patients undergoing major hip surgery in a university teaching hospital. We included patients who had an RRT or “code blue” activation post-surgery and within the index hospital admission. We extracted patient, surgical, anesthetic, and postoperative variables. We explored differences between patients who survived their index hospital stay and those who died. Discussion 187 (9%) patients had a postoperative RRT activation. The median age was 84.0 (78–90) years; 125 (67%) were female, and most patients had significant comorbidities. The median Charlson Comorbidity Index (CCI) was 5.0 (4.0–7.0). Patients were frail (68%), ASA physical status ≥Class 3 (91%) and underwent emergency surgery (88%). Death after RRT activation occurred in 1 in 7 patients. Compared to patients who survived RRT activation, those who died had a higher mean CCI (6.5 [1.8] vs. 5.5 [2.1], P = 0.02), were more frail (80.1% vs. 56.5%, OR = 3.2, 95% CI: 1.2,8.1; P = 0.03), and received less intraoperative opioids (intravenous morphine equi-analgesia: median = 5.8 (0.1–8.20 vs. 11.7 (3.7–19.0) mg, P = 0.03). Conclusion Mortality after RRT activation is associated with non-modifiable patients factors rather than surgical or anesthesia factors. Our findings provide opportunities for the implementation of strategies aimed at improving postoperative outcomes.

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“…The composition of a RRT can include critical care physicians, anesthetists, critical care nurses and respiratory therapists (2). Major surgery poses a signi cant physiological challenge to patients, which in turn can predispose them to an increased risk of postoperative deterioration (3,4). Past case-control and cross-sectional studies have implicated an array of preoperative and anesthetic factors that may be associated with postoperative patient deterioration and the need for RRT activation (5-7).…”

Section: Introductionmentioning

confidence: 99%

Rapid Response Team Activation After Major Hip Surgery: Patient Characteristics and Outcomes

Pritchard¹,

Jones²,

Bellomo³

et al. 2020

Preprint

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Background: Rapid Response Teams (RRT) are a critical care resource that reviews deteriorating patients within the hospital. Whilst contemporary literature has focused on outcomes of RRTs, little is known about the detailed perioperative course and characteristics of patients who require RRT activation after major hip surgery. We aimed to describe demographic, preoperative, surgical, anesthetic and postoperative characteristics of patients who required RRT activation after major hip surgery. We also sought to assess if these characteristics affected mortality during the index hospital admission. Methods: We reviewed a RRT database of adult patients undergoing orthopedic surgery at a university teaching hospital. We then retrospectively reviewed the medical records to extract a priori defined patient, preoperative, surgical, anesthetic and postoperative data of major hip surgery admissions between September 2014 and December 2017. Patients who survived the index hospital stay were compared to those who died.Results: Overall, 187 patients had a postoperative RRT activations. Mean (SD) age was 82.1 (11.6) years; 125 (67%) were female and most patients had at least one significant comorbidity: mean (SD) Charlson Comorbidity Index (CCI) of 5.6 (2.1). The majority of patients (68%) were frail, ASA class 3 or greater (91%) and underwent non-elective surgery (88%). Median (IQR) time from surgery to RRT activation was 29.4 hours (11.3:75.0), and 25 (13%) patients had unplanned admissions to ICU/HDU. Compared to patients who survived RRT activation, those who died displayed higher CCI [6.5 (1.8) vs. 5.5 (2.1); p=0.02], were more frail (80.1% vs. 56.5%; odds ratio 3.2; 95%CI: 1.2 to 8.1; p=0.03) and received less intraoperative opioids [median (IQR) intravenous morphine equi-analgesia 5.8 (0.1:8.2) mg vs. 11.7 (3.7:19.0) mg; p=0.03]. They were also more likely to receive an urgent medical review prior to RRT activation (62% vs 40%; odds ratio 2.4; 95%CI: 1.1 to 5.6; p=0.05).Conclusions: Death after RRT activation occurred in 1 out of 7 patients undergoing major hip surgery. Common patient characteristics included advanced age (>82 years), frailty, high CCI and emergency surgery. Further studies investigating perioperative surveillance teams in the identification of the high-risk patients before surgery, and deteriorating patients after major hip surgery, are warranted.

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Medical emergency team activation in patients pre- and post-liver transplantation is associated with prolonged length of stay and higher morbidity

Cited by 4 publications

References 0 publications

Rapid Response Team activation after major hip surgery: patient characteristics and outcomes

Rapid Response Team activation after major hip surgery: patient characteristics and outcomes

Rapid response team activation after major hip surgery: A case series

Rapid Response Team Activation After Major Hip Surgery: Patient Characteristics and Outcomes

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