Developing models to predict early postoperative patient deterioration and adverse events

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Excerpt

Multiple factors should be considered when planning perioperative care. Postoperative patients are at risk of acute deterioration, with almost 10% of hospital‐wide rapid response team (RRT) callouts occurring within 24 h of surgery1 and almost 1% of these requiring an unplanned intensive care unit (ICU) admission in the same period.2 Risk stratification tools aiding perioperative decisions have the potential to improve health outcomes by directing high‐risk patients to high‐acuity facilities.3 Such tools also have key resource benefits by guiding the allocation of postoperative ICU beds and the distribution of patients between central and peripheral surgical centres.4
A number of models have analysed the risk of surgical outcomes such as 30‐day mortality and end‐organ dysfunction. These include the National Surgical Quality Improvement Program Surgical Risk Calculator,5 POSSUM,6 and the Goldman Cardiac Risk Index.7 These are often context‐specific, and their focus on outcomes beyond the early postoperative period provides limited value in guiding perioperative decisions. In contrast, predicting potentially life‐threatening complications, and the need for intervention early in the postoperative period, is critical to planning surgical lists and determining the need for high‐acuity postoperative care. Early complications therefore represent a more relevant endpoint in perioperative risk stratification.
Since the late 1990s, many Australian hospitals have used a rapid response system to provide physician‐directed acute care for the management of deteriorating patients.8 RRT criteria represent early triggers for intervention,9 and may therefore be markers of acute deterioration for patients at risk of postoperative complications. These criteria are used commonly and consistently in clinical practice, and so may be useful endpoints for predictive risk modelling. Furthermore, their presence in the postanaesthesia care unit (PACU) may be indicative of subsequent complications on the wards.
Preoperative assessment acts as a key data source in determining perioperative risk and a triage point for postoperative care, and patient progress in PACU may represent a second triage point for referral to high acuity care. This study therefore examined the relationship of preoperative, operative and PACU data with that of ward‐based patient adverse events in the early postoperative period.
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