Risk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing?

Adeleke, Ibukun; Chae, Christina; Okocha, Obianuju; Sweitzer, Bobbie Jean

doi:10.1016/j.bpa.2020.11.010

Cited by 11 publications

(9 citation statements)

References 69 publications

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“…Using the RCRI, these high risk patients may be identified early on which could allow for a more efficient allocation of expertise and resources [46]. It could also enable the quantification of risk for patients and family members to aid them in participating in the decision making process around critical care, operative interventions, and even goals-of-care [47,48].…”

Section: Discussionmentioning

confidence: 99%

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

Forssten

Bass

Scheufler

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. Methods All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. Results 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. Conclusion An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.

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Section: Discussionmentioning

confidence: 99%

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

Forssten

Bass

Scheufler

et al. 2021

Eur J Trauma Emerg Surg

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show abstract

“…Early identification of at-risk patients allows mobilization of resources and expertise in the perioperative phase that may abrogate this risk of adverse outcomes or failure-to-rescue events 34–37 . In addition to their validated applicability to clinical risk management, prognostic tools also facilitate the illustration of quantifiable risk to patients, empowering patient and family involvement and augmenting shared decision-making 38 – 40 .…”

Section: Discussionmentioning

confidence: 99%

Cardiac risk stratification in emergency resection for colonic tumours

et al. 2021

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Background Despite advances in perioperative care, the postoperative mortality rate after emergency oncological colonic resection remains high. Risk stratification may allow targeted perioperative optimization and cardiac risk stratification. This study aimed to test the hypothesis that the Revised Cardiac Risk Index (RCRI), a user-friendly tool, could identify patients who would benefit most from perioperative cardiac risk mitigation. Methods Patients who underwent emergency resection for colonic cancer from 2007 to 2017 and registered in the Swedish Colorectal Cancer Registry (SCRCR) were analysed retrospectively. These patients were cross-referenced by social security number to the Swedish National Board of Health and Welfare data set, a government registry of mortality, and co-morbidity data. RCRI scores were calculated for each patient and correlated with 90-day postoperative mortality risk, using Poisson regression with robust error of variance. Results Some 5703 patients met the study inclusion criteria. A linear increase in crude 90-day postoperative mortality was detected with increasing RCRI score (37.3 versus 11.3 per cent for RCRI 4 or more versus RCRI 1; P < 0.001). The adjusted 90-day all-cause mortality risk was also significantly increased (RCRI 4 or more versus RCRI 1: adjusted incidence rate ratio 2.07, 95 per cent c.i. 1.49 to 2.89; P < 0.001). Conclusion This study documented an association between increasing cardiac risk and 90-day postoperative mortality. Those undergoing emergency colorectal surgery for cancer with a raised RCRI score should be considered high-risk patients who would most likely benefit from enhanced postoperative monitoring and critical care expertise.

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“…However, a time course of 24 to 48 hours is often not su cient to achieve comprehensive pre-operative risk mitigation [21]. In order to have adequate lead time for the potential pre-operative improvement of the patient's health, one approach might be to provide information via the internet during video consultation days to weeks before their hospital stay.…”

Section: Time Frame Of Informed Consentmentioning

confidence: 99%

“…In order to have adequate lead time for the potential pre-operative improvement of the patient's health, one approach might be to provide information via the internet during video consultation days to weeks before their hospital stay. This might be a systematic attempt to improve patient safety, which should be the primary goal [21]. Another bene t might be the avoidance of unnecessary pre-anaesthesia on-site visits for patients without major preexisting conditions.…”

Section: Time Frame Of Informed Consentmentioning

confidence: 99%

Remote anaesthesia patient informed consent - an overview of the current implementation in Europe

Straßberger‐Nerschbach

Delis

Kamp

et al. 2022

Preprint

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Background Digitalisation in the health system is a topic that is rapidly gaining popularity, not only because of the current pandemic. As in many areas of daily life, digitalisation is becoming increasingly important in the medical field amid the exponential rise in the use of computers and smartphones. This opens up new possibilities for optimising patient education in the context of anaesthesia. The main aim of this study was to assess the implementation of remote consent in Europe. Methods An online survey entitled “Digital online Patient Informed Consent for Anaesthesia before Elective Surgery. Recent practice in Europe”, with a total of 27 questions was sent by the European Society of Anaesthesiology and Intensive Care (ESAIC) to their members in 47 European countries. To assess the effect of economy on digitalisation and legal status with regard to anaesthesia consent, data were stratified based on Gross Domestic Product Per Capita (GDPPC). Results 23.1% and 37.2% of the 930 participants indicated that it was possible to obtain consent online or via telephone, respectively. This observation was more often reported in countries with high GDPPC levels than in countries with low GDPPC levels. Furthermore, 27.3% of responses for simple, 18.7% for complex, and 32.2% for repeated anaesthesia indicated that remote consent was in accordance with the law and was especially prevalent in countries with high GDPPC. Concerning the timing of consent, patients were informed at least one day before in 67.1% for simple and in 85.2% for complex procedures. Conclusion Even European countries with high GDPPC use remote informed consent only in a minority of cases and most of the time for repeated anaesthetic procedures. This might reflect the inconsistent legal situation and inhomogeneous medical technical structures across Europe.

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Risk assessment and risk stratification for perioperative complications and mitigation: Where should the focus be? How are we doing?

Cited by 11 publications

References 69 publications

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

Cardiac risk stratification in emergency resection for colonic tumours

Remote anaesthesia patient informed consent - an overview of the current implementation in Europe

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