Multicenter Study of General Anesthesia III. Predictors of Severe Perioperative Adverse Outcomes

Forrest, James B.; Rehder, Kai; Cahalan, Michael K.; Goldsmith, Charles H.

doi:10.1097/00000542-199201000-00002

Cited by 303 publications

(119 citation statements)

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“…There have been several other large studies of outcome after anaesthesia [1][2][3][4]. These were established primarily to estimate important predictors of outcome [2][3][4] and also to compare various anaesthetic techniques [4].…”

Section: Discussionmentioning

confidence: 99%

“…These were established primarily to estimate important predictors of outcome [2][3][4] and also to compare various anaesthetic techniques [4]. Gender has not been found to be a significant predictor of mortality or severe morbidity, though Forrest et al [4] found that males were more likely to have severe postoperative respiratory complications and Warden et al [1] found a preponderance of males in their mortality figures, though they did not adjust for patient and surgical factors. Nevertheless, severe morbidity and mortality were the focus of these studies and 'minor' complications were not reported.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally accepted that anaesthesia and surgery are associated with a low incidence of mortality or significant morbidity [1][2][3][4]. Because mortality associated with anaesthesia is so low, there has been an increasing tendency for anaesthetic quality assurance programmes to monitor either anaesthetic morbidity or critical incidents [5].…”

mentioning

confidence: 99%

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Postoperative ‘minor’ complications

1997

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SummaryWe compared the incidence of postoperative complications in women (vs. men) in 4173 patients. Overall, women were almost twice as likely to report any postoperative complication (RR = 1.92, p < 0.0005). Specifically, they were 2.6 times more likely to report nausea and vomiting (p < 0.0005), 1.5 times more likely to report sore throat (p = 0.0001), 2.3 times more likely to report headache (p < 0.0005) and 2.4 times more likely to report backache (p = 0.0036). Whether these gender differences are due to a reporting bias, or whether in fact women are at greater risk of such complications, remains to be determined.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postoperative ‘minor’ complications

1997

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“…Several anaesthetic morbidity studies have mainly focused on complications occurring in the intra-operative period and/or in the recovery unit and the incidence [1][2][3][4][5] and risk factors [2,4,5] of these complications have been estimated and identified. The length of patient follow-up after discharge from a recovery unit has varied between studies, ranging from 24 h postoperatively to time of hospital discharge [6][7][8][9].…”

mentioning

confidence: 99%

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

et al. 1998

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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.

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“…Obesity is a well-established predictor for severe pulmonary complications after surgery and is associated with marked increases in morbidity and mortality. 21,22 Respiratory impairment in obese patients caused by mass loading and splinting of the diaphragm is exacerbated by general anesthesia. 23 Increased minute ventilation to maintain normocapnea, augmented by an increased respiratory drive associated with liver disease, 24 helps explain the occurrence of respiratory insufficiency in 56% of our obese patients who were not extubated.…”

Section: Discussionmentioning

confidence: 99%

Reduced use of intensive care after liver transplantation: Patient attributes that determine early transfer to surgical wards

Mandell

Lezotte

Kam

et al. 2002

Liver Transplantation

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Part 1 of our report, presented in the same issue of the Journal, shows that immediate postoperative extubation and direct transfer to the surgical ward is safe and reduces reliance on the intensive care unit in most liver transplant recipients. However, there is no method to preoperatively predict which patients will need ventilatory support after surgery. To address this issue, we examined the relationship between perioperative patient attributes and extubation outcome in patients entered into our immediate postoperative extubation study from 1996 to 1998. Variables chosen stemmed from considerations in the literature. We examined the influence of 13 preoperative and 6 intraoperative factors on extubation outcome. Preoperative attributes included sex, race, diagnosis, United Network for Organ Sharing status, Child-Pugh score, presence of a portosystemic shunt, ascites, encephalopathy, coagulation, age, body mass index (BMI), creatinine level, and year of surgery. Intraoperative factors were type of surgery, surgeon, anesthesiologist, number of red blood cells administered, length of surgery, and surgical start time. Female sex (P ‫؍‬ .02), BMI of 32 or greater (P ‫؍‬ .015), portosystemic shunt (P ‫؍‬ .022), and encephalopathy (P ‫؍‬ .041) were associated with no attempt by the physician to extubate, whereas encephalopathy (P ‫؍‬ .01) and BMI of 34 or greater (P ‫؍‬ .002) were associated with failure to meet criteria for postoperative extubation (described in part 1 of this study). We conclude there are limited factors that predict an increased risk for postoperative respiratory failure in liver transplant recipients. Our results indicate that physicians are conservative in their approach to extubation immediately after surgery, and sole reliance on physician judgment to determine suitability for postoperative extubation leads to unnecessary use of postoperative cardiopulmonary support. (Liver Transpl 2002;8:682-687.)

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Multicenter Study of General Anesthesia III. Predictors of Severe Perioperative Adverse Outcomes

Cited by 303 publications

References 0 publications

Postoperative ‘minor’ complications

Postoperative ‘minor’ complications

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

Reduced use of intensive care after liver transplantation: Patient attributes that determine early transfer to surgical wards

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