The Use of a Postoperative Morbidity Survey to Evaluate Patients with Prolonged Hospitalization After Routine, Moderate-Risk, Elective Surgery

Bennett-Guerrero, E.; Welsby, Ian J.; Dunn, T. J.; Young, L. R.; Wahl, T. A.; Diers, T. L.; Phillips-Bute, Barbara; Newman, Mark F.; Mythen, Monty

doi:10.1097/00000539-199908000-00050

Cited by 157 publications

(136 citation statements)

References 31 publications

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“…On the basis of previous studies, ≥60% of patients on postoperative day 2 sustain significant morbidity [15, 16]. The sample size calculation (STATA version 10) has been detailed previously; briefly, at a statistical significance level of 5%, with a power of 80%, we estimated that at least 102 patients per treatment group would be required (allowing for ∼15% of patients to achieve their oxygen delivery target regardless of intervention, and taking into account a further 20% dropout rate as a result of failure to adhere to the protocol and/or intraoperative withdrawals).…”

Section: Methodsmentioning

confidence: 99%

Postoperative goal-directed therapy and development of acute kidney injury following major elective noncardiac surgery: post-hoc analysis of POM-O randomized controlled trial

et al. 2017

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Background: The role of goal-directed therapy (GDT) in preventing creatinine rise following noncardiac surgery is unclear. We performed a post-hoc analysis of a randomized controlled trial to assess the relationship between postoperative optimization of oxygen delivery and development of acute kidney injury (AKI)/creatinine rise following noncardiac surgery. Methods: Patients were randomly assigned immediately postoperatively to receive either fluid and/or dobutamine therapy to maintain/restore their preoperative oxygen delivery, or protocolized standard care (oxygen delivery only recorded). Primary end point was serial changes in postoperative creatinine within 48 h postoperatively. Secondary outcomes were development of AKI (KDIGO criteria) and minimal creatinine rise (MCR; no decline from preoperative creatinine), related to all-cause morbidity and length of stay. Results: Postoperative reductions in serum creatinine were similar (P = 0.76) in patients randomized to GDT [10 µmol/L (95% confidence interval, CI: 17 to −1); n = 95] or protocolized care [8 µmol/L (95% CI: 17 to −6); n = 92]. Postoperative haemodynamic management was not associated with the development of MCR [78/187 (41.7%)] or AKI [13/187; (7.0%)]. Intraoperative requirement for norepinephrine was more likely in patients who developed postoperative rises in creatinine [relative risk (RR): 1.66 (95% CI: 1.04–2.67); P = 0.04], despite similar volumes of intraoperative fluid being administered. Persistently higher lactate during the intervention period was associated with AKI (mean difference: 1.15 mmol/L (95% CI: 0.48–1.81); P = 0.01]. Prolonged hospital stay was associated with AKI but not MCR [RR: 2.71 (95% CI: 1.51–4.87); P = 0.0008]. Conclusion: These data provide further insights into how perioperative haemodynamic alterations relate to postoperative increases in creatinine once systemic inflammation is established.

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Section: Methodsmentioning

confidence: 99%

Postoperative goal-directed therapy and development of acute kidney injury following major elective noncardiac surgery: post-hoc analysis of POM-O randomized controlled trial

et al. 2017

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“…[1] and Bennett-Guerrero et al . [10] The checklist included all complications arising from the respiratory, gastrointestinal, cardiovascular, neurological systems, any pain requiring opiates, and systemic and local infection.…”

Section: Methodsmentioning

confidence: 99%

Renal water conservation determines the increase in body weight after surgery: A randomized, controlled trial

Hahn

2017

Saudi J Anaesth

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Background:The present study was undertaken to identify factors that correlate with the gain in body weight after surgery.Methods:Twenty-one patients (median age of 49 years) were randomized to receive either Ringer × s acetate or 6% dextran 70 as their first infusion fluid during cholecystectomy or hysterectomy. Each patient's body weight was measured before the surgery and on the first postoperative morning. Blood and urine samples were analyzed for signs of stress, inflammation, and kidney injury. The fluid retention index (FRI), which reflects how strongly the kidneys excrete or retain fluid, was also calculated.Results:The body weight increased by a median of 0.4 kg in the crystalloid fluid group and by 1.0 kg in the colloid fluid group (maximum 2.5 kg, P < 0.01). This difference was due to less urinary excretion after surgery in the colloid group (P < 0.03). The increase in body weight did not correlate with the infused fluid volume, the plasma concentrations of C-reactive protein or cortisol, or the urinary excretion of albumin, cortisol, or neutrophil gelatinase-associated lipocalin. However, the body weight increased with the postoperative FRI score (r = 0.64; P < 0.003) and with the surgery-induced change in FRI score (r = 0.72; P < 0.002).Conclusion:How strongly the kidneys excrete or retain fluid, which can be assessed by urine sampling, was the strongest indicator of the increase in body weight during the day of surgery. The amount of fluid alone did not correlate with the gain in body weight.

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“…The POMS [9, 10] is a validated measure of short-term post-operative harm which includes an 18-item tool that addresses nine domains of morbidity relevant to the post-surgical patient: pulmonary, infection, renal, gastrointestinal, cardiovascular, neurological, wound complications, haematological and pain. For each domain either presence or absence of morbidity will be recorded on the basis of precisely defined clinical criteria.…”

Section: Methodsmentioning

confidence: 99%

The effect of neoadjuvant chemotherapy and chemoradiotherapy on exercise capacity and outcome following upper gastrointestinal cancer surgery: an observational cohort study

et al. 2016

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Background: In 2014 approximately 21,200 patients were diagnosed with oesophageal and gastric cancer in England and Wales, of whom 37 % underwent planned curative treatments. Potentially curative surgical resection is associated with significant morbidity and mortality. For operable locally advanced disease, neoadjuvant chemotherapy (NAC) improves survival over surgery alone. However, NAC carries the risk of toxicity and is associated with a decrease in physical fitness, which may in turn influence subsequent clinical outcome. Lower levels of physical fitness are associated with worse outcome following major surgery in general and Upper Gastrointestinal Surgery (UGI) surgery in particular. Cardiopulmonary exercise testing (CPET) provides an objective assessment of physical fitness. The aim of this study is to test the hypothesis that NAC prior to upper gastrointestinal cancer surgery is associated with a decrease in physical fitness and that the magnitude of the change in physical fitness will predict mortality 1 year following surgery.

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The Use of a Postoperative Morbidity Survey to Evaluate Patients with Prolonged Hospitalization After Routine, Moderate-Risk, Elective Surgery

Cited by 157 publications

References 31 publications

Postoperative goal-directed therapy and development of acute kidney injury following major elective noncardiac surgery: post-hoc analysis of POM-O randomized controlled trial

Postoperative goal-directed therapy and development of acute kidney injury following major elective noncardiac surgery: post-hoc analysis of POM-O randomized controlled trial

Renal water conservation determines the increase in body weight after surgery: A randomized, controlled trial

The effect of neoadjuvant chemotherapy and chemoradiotherapy on exercise capacity and outcome following upper gastrointestinal cancer surgery: an observational cohort study

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