Early postoperative emergencies requiring an intensive care team interventionThe role of ASA physical status and after‐hours surgery

Abstract

SummaryTo examine the risk factors of early postoperative emergencies that required an intensive care team intervention, a matched nested case-control study (34 cases and 126 controls) was conducted. Over a 17-month period, the incidence of early postoperative emergencies occurring within 48 h of surgery was 0.21% (95% confidence intervals (CI): 0.14%-0.30%). The intensive care team treated two cardiac arrests and three respiratory arrests. The major physiological changes which led to ward staff summoning an intensive care team were hypotension (13 cases) and a decreased level of consciousness (nine cases). Significant associations with early postoperative emergencies were high ASA (Ն IV) physical status grades (odds ratio: 4.51, 95% CI: 1.24-16.40) and surgery performed outside normal working hours (odds ratio: 4.40, 95% CI: 1.41-13.69). High-risk patients may benefit from a visit by a postoperative care team during the early postoperative period but this requires further evaluation.

Postoperative Emergency Response Team Activation at a Large Tertiary Medical Center

“…22 In our patients, acute postoperative decline in neurologic function was a frequent cause for ERT activation. Similarly, Lee et al 16 reported a decline in mental status as a common reason for ERT activation; however, they did not comment on preoperative neurologic disease as a risk factor. The relatively small number of patients in our study with this condition precludes us from making a general recommendation regarding preemptive triage of these patients to a higher level of postoperative care.…”

“…16 A small case-control study identified ASA Physical Status class 3 or greater and after-hours surgery as predictors. As in our study, hypotension and decreased level of consciousness were the main reasons for ERT activation.…”

“…As in our study, hypotension and decreased level of consciousness were the main reasons for ERT activation. 16 That study used ASA Physical Status as a surrogate for comorbidity, 16 but the small cohort precluded examining the relationship between specific comorbidities and intraoperative events with early postoperative complications. In our larger series, we identified 3 markers for increased postoperative ERT activation.…”

Dedicated operating room for emergency surgery improves access and efficiency

“…One study identified a significant association between surgery performed after-hours (6:00 pm to 8:00 am) and early postoperative complications. 16 Bhattacharyya 6 found a significant increase in minor surgical complications for femoral nailings performed after 5:00 pm. These complications included prominently placed distal locking screws, malrotation and a femoral neck fracture that the author believed was missed on preoperative radiographs.…”

The clinical utility of preoperative surgical risk indices and ICU bed allocation on outcomes of noncardiac surgical patients: A cohort study

“…Previous studies have demonstrated that one third of postoperative complications and one fourth of deaths occur within the first 48 hours after surgery [30]. These early postoperative complications such as hypotension, hypertension, tachycardia, hypoxemia, hypercapnea, a decreased level of consciousness and operations outside of normal work hours predict unplanned ICU admissions and may add predictive value to preoperative risk factors in the allocation of ICU beds [31][32][33].…”