Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study

Rhodes, Andrew; Cecconi, Maurizio; Hamilton, Mark A.; Poloniecki, Jan; Woods, Justin; Boyd, Owen; Bennett, David; Grounds, R. M.

doi:10.1007/s00134-010-1869-6

Cited by 157 publications

(66 citation statements)

References 20 publications

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“…In a 15‐year follow‐up study, Rhodes et al 25. found an HR of 1·93; thus a similar value was used for the present study population.…”

Section: Discussionmentioning

confidence: 81%

“…For example, if an individual has a life expectancy of 7 years, and the QALY value is 0·66 for the first year after operation, 0·71 for the second and third years, and 0·75 for the last 4 years, the adjusted life expectancy is 5·08 years (1*0·66 + 2*0·71 + 4*0·75). Finally, life expectancy was adjusted to account for increased risk of death following an ICU episode and complications after surgery24, 25, 26, 27.…”

Section: Methodsmentioning

confidence: 99%

“…Long‐term effects were calculated by extrapolating the results using external evidence on utility and risk of death after survival in the ICU21, 22, 23, 24, 25, 26. A predictive modelling technique was then applied.…”

Section: Methodsmentioning

confidence: 99%

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Cost‐effectiveness of a quality improvement bundle for emergency laparotomy

Ebm¹,

Aggarwal

Huddart

et al. 2018

BJS Open

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BackgroundThe recent Emergency Laparotomy Pathway Quality Improvement Care (ELPQuiC) study showed that the use of a specific care bundle reduced mortality in patients undergoing emergency laparotomy. However, the costs of implementation of the ELPQuiC bundle remain unknown. The aim of this study was to assess the in‐hospital and societal costs of implementing the ELPQuiC bundle.MethodsThe ELPQuiC study employed a before–after approach using quality improvement methodology. To assess the costs and cost‐effectiveness of the bundle, two models were constructed: a short‐term model to assess in‐hospital costs and a long‐term model (societal decision tree) to evaluate the patient's lifetime costs (in euros).ResultsUsing health economic modelling and data collected from the ELPQuiC study, estimated costs for initial implementation of the ELPQuiC bundle were €30 026·11 (range 1794·64–40 784·06) per hospital. In‐hospital costs per patient were estimated at €14 817·24 for standard (non‐care bundle) treatment versus €15 971·24 for the ELPQuiC bundle treatment. Taking a societal perspective, lifetime costs of the patient in the standard group were €23 058·87, compared with €19 102·37 for patients receiving the ELPQuiC bundle. The increased life expectancy of 4 months for patients treated with the ELPQuiC bundle was associated with cost savings of €11 410·38 per quality‐adjusted life‐year saved.ConclusionImplementation of the ELPQuiC bundle is associated with lower mortality and higher in‐hospital costs but reduced societal costs.

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“…In a 15‐year follow‐up study, Rhodes et al 25. found an HR of 1·93; thus a similar value was used for the present study population.…”

Section: Discussionmentioning

confidence: 81%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Cost‐effectiveness of a quality improvement bundle for emergency laparotomy

Ebm¹,

Aggarwal

Huddart

et al. 2018

BJS Open

View full text Add to dashboard Cite

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“…We now know that these interventions during the perioperative period may change long-term outcomes (90).…”

Section: Therapies…mentioning

confidence: 99%

Perioperative Haemodynamic Optimisation

Aya¹,

Cecconi²,

Rhodes³

2014

Turk J Anesth Reanim

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56During the latest years, a number of studies have confirmed the benefits of perioperative haemodynamic optimisation on surgical mortality and postoperative complication rate. This process requires the use of advanced haemodynamic monitoring with the purpose of guiding therapies to reach predefined goals. This review aim to present recent evidence on perioperative goal directed therapy (GDT), with an emphasis in some aspects that may merit further investigation. In order to maximise the benefits on outcomes, GDT must be implemented as early as possible; intravascular volume optimisation should be in accordance with the response of the preload-reserve, goals should be individualised and adequacy of the intervention must be also assessed; non-invasive or minimally invasive monitoring should be used and, finally, side effects of every therapy should be taken into account in order to avoid undesired complications. New drugs and technologies, particularly those exploring the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of this group of therapeutic interventions.

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“…Although benefits of GDFT were prevailing in early reports [1], the more recent data showed no benefit [6] or even worse outcomes [7].These controversial findings may find explanation in the following. An ultimate goal of optimized circulation is maintaining or improving organ perfusion and oxygen delivery to tissues.…”

mentioning

confidence: 95%

In Silico Testing of the Semi-Closed Loop Infusion System with a New Simulator

Markevičius

Andrijauskas

Navikas

et al. 2014

ElAEE

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However, there is evidence that hemodynamic optimization may not be sufficient for achieving the better results of treatment. Although benefits of GDFT were prevailing in early reports [1], the more recent data showed no benefit [6] or even worse outcomes [7].These controversial findings may find explanation in the following. An ultimate goal of optimized circulation is maintaining or improving organ perfusion and oxygen delivery to tissues. Thus, swelling of tissues (edema) is a concern. Volume kinetics indicated that 65 %-70 % of crystalloid solution usually remains in blood vessels at the end of infusion, whereas only 20 %-25 % remains therein 20 min later [8]. Most of the volume which leaves circulation soon after infusion is translocated into tissues. However, conventional clinical methods are not sufficiently sensitive and specific for the detection of when the necessary fluid accumulation in tissues turns into edema during hemodynamic optimization by fluids. Thus, a mini Volume Loading Test (mVLT) for detection of imminent edema during stepwise infusion was proposed

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Goal-directed therapy in high-risk surgical patients: a 15-year follow-up study

Cited by 157 publications

References 20 publications

Cost‐effectiveness of a quality improvement bundle for emergency laparotomy

Cost‐effectiveness of a quality improvement bundle for emergency laparotomy

Perioperative Haemodynamic Optimisation

In Silico Testing of the Semi-Closed Loop Infusion System with a New Simulator

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