Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial)

Abstract

NCT01209663 (http://www.clinicaltrials.gov).

Multidisciplinary perioperative protocol in patients undergoing acute high-risk abdominal surgery

“…Internationally, ICU capacity and criteria vary enormously, and the external validity of the results regarding intensive care utilization is low. In Denmark and many other countries, patients undergoing AHA surgery are not offered ICU care as standard, and admission is on specific indication. As ICU admission and discharge criteria were unchanged in this study, a shorter length of stay in the ICU could be seen as a proxy for faster recovery of organ dysfunction in the intervention group.…”

“…Randomization is challenged by the nature of emergency surgery. In several studies, these challenges have been reflected in a small proportion of eligible patients being randomized, minimizing external validity. Furthermore, performing a single‐centre RCT with complex interventions in acute care surgery is not feasible because of the high probability of a spillover effect from the intervention cohort to the control cohort.…”

“…The acute abdomen is the most frequent non‐trauma surgical reason for emergency hospital admission. Despite a large number of patients undergoing acute high‐risk abdominal (AHA) surgery with a high risk of morbidity and mortality, and substantial socioeconomic costs, there has been limited focus on optimized surgical regimens to improve surgical outcomes. The traditional perioperative treatment of patients undergoing AHA surgery is controversial and founded primarily on non‐standardized treatment practice rather than evidence, and cultural and logistic challenges in emergency surgery are being debated.…”

Perioperative medicine and mortality after elective and emergency surgery

“…4 Vaster-Andersen et al 5 made the same observation in the Danish In Care Trial study. The same relationship was observed in hospitalised patients with sudden clinical deterioration -the number of ICU beds available and the hospital mortality were not associated.…”

Post‐operative serious adverse events in a mixed surgical population – a retrospective register study

“…Several studies have investigated the mortality and post-operative complications in a wide variety of surgical populations, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] but in the majority of studies, observation time is short and appears to vary between in-hospital, 30-day, and 90-day mortality.…”