Can we accurately assess an individual's perioperative risk?

Reilly, CS

doi:10.1093/bja/aen314

Cited by 22 publications

(21 citation statements)

References 18 publications

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“…[70][71][72] This highlights that recovery is a multifactorial concept that preoperative risk stratification cannot predict in its entirety at the individual patient level. 73,74 Thus, it is essential that there is real-time assessment of patient recovery in order to detect those patients who might benefit from a timely intervention.…”

Section: Domain-specific Assessmentmentioning

confidence: 99%

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Bowyer

Royse

2015

Can J Anesth/J Can Anesth

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Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. As a result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. Quality of care is often substituted as a surrogate at the institutional level for quality of recovery, but it is ideologically distinct from patients' perceived quality of care, recovery, and satisfaction. Recovery tools also differ in their assessment of recovery as a continuous vs dichotomous variable and in their focus at the group vs individual level. Ideally, recovery measures should assess outcomes in a simple dichotomous fashion and maintain relevancy by assessing in multiple domains at various time points. Assessment of recovery in a dichotomous fashion also has both clinical and research applications. It allows identification of suboptimal recovery at both individual and group levels, respectively, and when performed in real time, it allows the opportunity for timely targeted intervention specific to individual patients as well as for resource rationalization.Résumé La qualité de récupération est un construit complexe dont la définition est fortement influencée par les opinions et les biais du patient, du clinicien, voire de l'établissement. Dès lors, les outils d'évaluation de la récupération diffèrent de par la définition-même de la récupération, leur envergure, et le cadre temporel de l'évaluation. Une évaluation précise de la récupération est essentielle; en effet, une récupération sous-optimale a des implications tant économiques que pronostiques. Au niveau institutionnel, on utilise souvent la qualité des soins comme substitut de la qualité de récupération mais, d'un point de vue idéologique, ce concept se distingue de la qualité des soins, de la récupération et de la satisfaction telles que perçues par les patients. Les outils de récupération diffèrent également dans leur évaluation de la récupération en tant que variable continue ou dichotomique et dans leur emphase sur le groupe ou l'individu. Dans l'idéal, les mesures de la récupération devraient évaluer les pronostics de manière dichotomique simple et maintenir leur pertinence en évaluant plusieurs domaines à différents moments dans le temps. L'évaluation dichotomique de la récupération a également des applications cliniques et en recherche. Elle permet d'identifier une récupération sous-optimale tant au niveau du groupe que de l'individu. D'autre part, lorsque ce type d'évaluation est réalisé en temps réel, elle nous donne la possibilité d'intervenir d'une manière ciblée et opportune spécifique à chaque patient tout en rationnalisant les ressources.Author contributions Andrea Bowyer and Colin Royse contributed substantially to the conception and design of the manuscript and drafted the version to be published.

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Section: Domain-specific Assessmentmentioning

confidence: 99%

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

Bowyer

Royse

2015

Can J Anesth/J Can Anesth

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“…Although preoperative cardiac evaluation has improved during the past decades, we are not yet in the situation where we can accurately predict individual perioperative risk [110]. There are several reasons for that.…”

Section: Resultsmentioning

confidence: 99%

Editorial [Hot Topic Recent Advances in Anesthetic Management (Executive Guest Editors: Ehab Farag and D. John Doyle)]

Farag¹,

Dj²

2012

CPD

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Underlying cardiovascular disease is a potentially modifiable risk factor that contributes significantly to perioperative morbidity and mortality. Reducing perioperative and long-term morbidity and mortality requires risk modifying perioperative management. This, in turn, requires preoperative identification of patients with, or at risk of having cardiovascular disease. Preoperative cardiac evaluation includes, (i) recognition and treatment of active cardiac conditions, (ii) assessment of surgical risk, functional capacity, and clinical risk factors, (iii) identification of candidates for non-invasive cardiac testing, coronary angiography and preoperative coronary revascularization, and (iv) pharmacologic management. A cardiac risk assessment algorithm is useful in guiding systematic evaluation. Although preoperative cardiac evaluation has improved during the past decades, we are not yet in the situation where we can accurately predict individual perioperative risk because the individual stress response to a given stressor, and the individual interactions between pharmacological intervention and intra-and postoperative risk factors are highly variable. Furthermore, preoperative cardiac evaluation is only one aspect of overall perioperative care. There are numerous intra-and postoperative factors which have been shown to affect overall outcome. Not all of them can reliably be predicted or modified in a way which improves outcome. However, recognition of such factors and aggressive attempts at appropriate intervention may reduce overall risk more than preoperative evaluation in isolation. Without defining and subsequently targeting intra-and postoperative risk factors, the benefit of preoperative cardiac evaluation will be limited.

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“…According to a preoperative questionnaire, the majority of patients had been severely overweight for between 15 and 20 years ( 24 smoking, asthma and diabetes mellitus were common findings in the morbidly obese group. In contrast, no one in the control group had, for example, a diagnosis of OSAS/ OHS or was suffering from dyspnoea (Tables 2 and 3).…”

Section: Resultsmentioning

confidence: 99%