Tanaka score predicts surgical intensive care admission following abdominal wall reconstruction

Said, Sayf; Thomas, J. David; Montelione, Katherine; Fafaj, Aldo; Beffa, Lucas; Krpata, David M.; Prabhu, Ajita S.; Rosen, Michael J.; Petro, Clayton C.

doi:10.1007/s10029-022-02605-x

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…Almost half (45%) of ICU planned patients did not undergo any intensive care specific intervention. The rate of ICU admissions (38%) was not only higher compared to similar studies (7-29%), patients were also much less complex, in terms of hernia size, LOD, comorbidities, infected wounds and concurrent operations, than reported in other studies [14,16]. This high level of caution by the MDT may be the result of a learning curve.…”

Section: Discussionmentioning

confidence: 67%

“…Multiple modifications of the HPW and Fischer score were tested using different combinations of their mutual risk factors. Also, factors not included in HPW or Fischer score, but reported in similar studies as relevant risk factors (LOD, age and gender) were also tested [11][12][13][14][15][16]. Data were analyzed in RStudio (version 1.2.5001).…”

Section: Methodsmentioning

confidence: 99%

“…CAWR leads to respiratory failure in 6-20% of patients, especially in case of risk factors like a large hernia, loss of domain (LOD), recurrent incarcerations, elderly patient, male, high ASA score, high BMI, COPD, infected wound or a concurrent intra-abdominal procedure (see Supplementary Table 1) [11][12][13][14][15][16][17][18]. In the absence of any guideline for ICU admission after CAWR, the European Collaborative strongly recommended, that 'intensive care beds must be available for all patients after CAWR' [5].…”

Section: Introductionmentioning

confidence: 99%

“…This statement implies cancelation of planned CAWRs, in case of limited Intensive Care Unit capacity, like during the Covid-10 pandemic. While empty critical care beds with adequate personnel staffing will always be a coveted resource, optimal risk-stratifying remains very essential [16].…”

Section: Introductionmentioning

confidence: 99%

“…In our hospital, the multidisciplinary team (MDT) decides whether a postoperative ICU bed needs to be planned for a specific patient. However, many patients were discharged from the ICU within 24 h after CAWR, without having been submitted to any specific ICU intervention, like monitoring vital signs by intravascular lines, applying hemodynamic support with vasopressor medication and/or applying pulmonary support by (non) invasive mechanical ventilation [16].…”

Section: Introductionmentioning

confidence: 99%

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Impact of a multidisciplinary team discussion on planned ICU admissions after complex abdominal wall reconstruction

Wegdam

Jong

Gielen

et al. 2023

Hernia

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Background Patients often need admission at an Intensive Care Unit (ICU), immediately after complex abdominal wall reconstruction (CAWR). Lack of ICU resources requires adequate patient selection for a planned postoperative ICU admission. Risk stratification tools like Fischer score and Hernia Patient Wound (HPW) classification may improve patient selection. This study evaluates the decision-making process in a multidisciplinary team (MDT) on justified ICU admissions for patients after CAWR. Methods A pre-Covid-19 pandemic cohort of patients, discussed in a MDT and subsequently underwent CAWR between 2016 and 2019, was analyzed. A justified ICU admission was defined by any intervention within the first 24 h postoperatively, considered not suitable for a nursing ward. The Fischer score predicts postoperative respiratory failure by eight parameters and a high score (> 2) warrants ICU admission. The HPW classification ranks complexity of hernia (size), patient (comorbidities) and wound (infected surgical field) in four stages, with increasing risk for postoperative complications. Stages II-IV point to ICU admission. Accuracy of the MDT decision and (modifications of) risk-stratification tools on justified ICU admissions were analyzed by backward stepwise multivariate logistic regression analysis. Results Pre-operatively, the MDT decided a planned ICU admission in 38% of all 232 CAWR patients. Intra-operative events changed the MDT decision in 15% of all CAWR patients. MDT overestimated ICU need in 45% of ICU planned patients and underestimated in 10% of nursing ward planned patients. Ultimately, 42% went to the ICU and 27% of all 232 CAWR patients were justified ICU patients. MDT accuracy was higher than the Fischer score, HPW classification or any modification of these risk stratification tools. Conclusion A MDT's decision for a planned ICU admission after complex abdominal wall reconstruction was more accurate than any of the other risk-stratifying tools. Fifteen percent of the patients experienced unexpected operative events that changed the MDT decision. This study demonstrated the added value of a MDT in the care pathway of patients with complex abdominal wall hernias.

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Section: Discussionmentioning

confidence: 67%