The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients
<h4>Background</h4> Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592468/?tool=EBI |
| _version_ | 1818988285748314112 |
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| author | Claudia de Souza Gutierrez Katia Bottega Stela Maris de Jezus Castro Gabriela Leal Gravina Eduardo Kohls Toralles Otávio Ritter Silveira Martins Wolnei Caumo Luciana Cadore Stefani |
| author_facet | Claudia de Souza Gutierrez Katia Bottega Stela Maris de Jezus Castro Gabriela Leal Gravina Eduardo Kohls Toralles Otávio Ritter Silveira Martins Wolnei Caumo Luciana Cadore Stefani |
| author_sort | Claudia de Souza Gutierrez |
| collection | DOAJ |
| description | <h4>Background</h4> Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. <h4>Methods</h4> A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. <h4>Results</h4> Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. <h4>Conclusion</h4> Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality. |
| first_indexed | 2024-12-20T19:20:09Z |
| format | Article |
| id | doaj.art-0fb53fbae7f74aff95662c8f0fb0c7e7 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T19:20:09Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0fb53fbae7f74aff95662c8f0fb0c7e72022-12-21T19:29:00ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-011611The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patientsClaudia de Souza GutierrezKatia BottegaStela Maris de Jezus CastroGabriela Leal GravinaEduardo Kohls TorallesOtávio Ritter Silveira MartinsWolnei CaumoLuciana Cadore Stefani<h4>Background</h4> Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients. <h4>Methods</h4> A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission. <h4>Results</h4> Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death. <h4>Conclusion</h4> Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592468/?tool=EBI |
| spellingShingle | Claudia de Souza Gutierrez Katia Bottega Stela Maris de Jezus Castro Gabriela Leal Gravina Eduardo Kohls Toralles Otávio Ritter Silveira Martins Wolnei Caumo Luciana Cadore Stefani The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients PLoS ONE |
| title | The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients |
| title_full | The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients |
| title_fullStr | The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients |
| title_full_unstemmed | The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients |
| title_short | The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients |
| title_sort | impact of the incorporation of a feasible postoperative mortality model at the post anaesthestic care unit pacu on postoperative clinical deterioration a pragmatic trial with 5 353 patients |
| url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8592468/?tool=EBI |
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