Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial

Vickery, Nicola; Stephens, Timothy; Toit, Leon du; Straaten, Dawid van; Pearse, Rupert M; Torborg, Alexandra; Rolt, Lucy; Puchert, Mariechen; Martin, Graham; Biccard, Bruce; Investigators, Asos

doi:10.1016/j.bja.2021.07.001

Cited by 8 publications

(2 citation statements)

References 23 publications

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“…The inability of this trial to improve outcomes was attributed to implementation challenges such as weak engagement and insufficient run‐in time to improve care. Additional challenges to enhance surgical care in LMICs have been identified, among them the wide variations in clinical assistance and scarce resources for quality improvement programmes [29].…”

Section: Discussionmentioning

confidence: 99%

Enhanced peri‐operative care to improve outcomes for high‐risk surgical patients in Brazil: a single‐centre before‐and‐after cohort study

et al. 2022

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Summary Mortality and morbidity for high‐risk surgical patients are often high, especially in low‐resource settings. Enhanced peri‐operative care has the potential to reduce preventable deaths but must be designed to meet local needs. This before‐and‐after cohort study aimed to assess the effectiveness of a postoperative 48‐hour enhanced care pathway for high‐risk surgical patients (‘high‐risk surgical bundle’) who did not meet the criteria for elective admission to intensive care. The pathway comprised of six elements: risk identification and communication; adoption of a high‐risk post‐anaesthesia care unit discharge checklist; prompt nursing admission to ward; intensification of vital signs monitoring; troponin measurement; and prompt access to medical support if required. The primary outcome was in‐hospital mortality. Data describing 1189 patients from two groups, before and after implementation of the pathway, were compared. The usual care group comprised a retrospective cohort of high‐risk surgical patients between September 2015 and December 2016. The intervention group prospectively included high‐risk surgical patients from February 2019 to March 2020. Unadjusted mortality rate was 10.5% (78/746) for the usual care and 6.3% (28/443) for the intervention group. After adjustment, the intervention effect remained significant (RR 0.46 (95%CI 0.30–0.72). The high‐risk surgical bundle group received more rapid response team calls (24% vs. 12.6%; RR 0.63 [95%CI 0.49–0.80]) and surgical re‐interventions (18.9 vs. 7.5%; RR 0.41 [95%CI 0.30–0.59]). These data suggest that a clinical pathway based on enhanced surveillance for high‐risk surgical patients in a resource‐constrained setting could reduce in‐hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Enhanced peri‐operative care to improve outcomes for high‐risk surgical patients in Brazil: a single‐centre before‐and‐after cohort study

et al. 2022

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“…Выявление этих факторов риска необходимо для понимания патофизиологии развития ослож нений и определения потенциальных пу тей снижения анесте зиологического риска, таких как коррекция сопутству ющего заболевания. Проведение национального ис следования, посвященного выявлению факторов риска неб лагоприятного исхода, -первый неотъемлемый шаг к созданию комплекса мер по улучшению качества пе риоперационной помощи и снижению летальности [22].…”

Section: вестник интенсивной терапии имени аи салтанова | Annals Of C...unclassified

National multicenter prospective observational study “The role of concomitant diseases in poSTOPerative complications RISK stratification — STOPRISK”: study protocol

Zabolotskikh

Трембач

Мусаева

et al. 2022

Annals of Critical Care

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INTRODUCTION: Advances in modern anesthesiology have significantly reduced the risk of anesthesia compared to the last century, however, the level of perioperative in-hospital mortality after elective major abdominal surgery is still high at the moment. Poor outcome prediction is the cornerstone of individualized perioperative management of high-risk patients aimed at preventing complications. Despite the fact that a large number of risk assessment tools have been developed over the past decades, the accuracy of the forecast is still far from required. According to the literature data, models based on the study of risk factors in the national population of patients, of which comorbidities make the greatest contribution, have the greatest accuracy. MATERIALS AND METHODS: Design: prospective observational study. Setting: National multicenter study of patients in surgical hospitals. Patients: Patients undergoing abdominal surgery. Interventions: Not provided. RESULTS: The developed design was registered in the ClinicalTrials.gov database, a study organized by the Federation of Anesthesiologists and Resuscitators of Russia in cooperation with the Kuban State Medical University has now begun, 38 centers are participating in it, two papers have been published based on the results of an interim analysis. CONCLUSIONS: The study is of great scientific and medical and social importance, as a result of the analysis of the data obtained, the role of concomitant diseases in the development of an adverse outcome will be studied and a national risk assessment model will be developed. REGISTRATION: Clinicaltrials.gov identifier: NCT03945968. Registered May 10, 2019.

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The need for data describing the surgical population in Latin America

Stefani¹,

Hajjar²,

Biccard³

et al. 2022

British Journal of Anaesthesia

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Understanding the performance of a pan-African intervention to reduce postoperative mortality: a mixed-methods process evaluation of the ASOS-2 trial

Cited by 8 publications

References 23 publications

Enhanced peri‐operative care to improve outcomes for high‐risk surgical patients in Brazil: a single‐centre before‐and‐after cohort study

Enhanced peri‐operative care to improve outcomes for high‐risk surgical patients in Brazil: a single‐centre before‐and‐after cohort study

National multicenter prospective observational study “The role of concomitant diseases in poSTOPerative complications RISK stratification — STOPRISK”: study protocol

The need for data describing the surgical population in Latin America

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