Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
Acta Anaesthesiol Scand. 2020 Nov;64(10):1431-1437. doi: 10.1111/aas.13668. Epub 2020 Jul 30.
A variety of rapid response systems (RRSs) based on the systematic assessment of vital signs and laboratory tests have been developed to reduce hospital mortality through the early detection of alarm signs, while deterioration may still be reversible. This study aimed to determine the association between alarm signs and post-operative hospital mortality during post-operative days (POD) 0-3 in patients undergoing non-cardiac surgery.
This retrospective observational study used data from the registry of a single tertiary academic hospital. The study population included patients who were ≥18 years old, admitted between 1 January 2013 and 30 June 2018 for non-cardiac surgery, and subsequently transferred to the general ward.
A total of 116 329 patients were included in the analysis. Among them, 10 099 patients (8.7%) showed positive alarm criteria and triggered the RRS in the post-operative ward during POD 0-3. In the multivariate logistic regression model, PaO <55 mm Hg, SpO <90%, and total CO <15 mmol/L were associated with a 3.57-, 3.46-, and 12.53-fold increase in post-operative hospital mortality, respectively. Moreover, when compared to the no alarm signs group, patients with 1, 2, 3, and ≥4 alarm signs showed a 2.79-, 2.76-, 6.54-, and 20.02-fold increase in hospital mortality, respectively.
Increased post-operative hospital mortality was found to be associated with alarm signs detected by the RRS during POD 0-3. The post-operative alarm signs detected by the RRS may therefore be useful in determining high-risk patients who require medical interventions in the surgical ward.
已经开发出各种基于生命体征和实验室检查系统评估的快速反应系统（RRS），以通过早期检测报警信号来降低医院死亡率，因为恶化仍可能是可逆的。本研究旨在确定在非心脏手术后的术后第 0-3 天（POD）期间，报警信号与术后医院死亡率之间的关联。
这是一项回顾性观察性研究，使用了来自一家单一的三级学术医院登记处的数据。研究人群包括年龄≥18 岁、在 2013 年 1 月 1 日至 2018 年 6 月 30 日期间接受非心脏手术并随后转至普通病房的患者。
共纳入 116329 例患者进行分析。其中，在术后第 0-3 天期间，有 10099 例患者（8.7%）表现出阳性报警标准并触发了 RRS。在多变量逻辑回归模型中，PaO <55mmHg、SpO <90%和总 CO <15mmol/L 与术后医院死亡率分别增加 3.57、3.46 和 12.53 倍相关。此外，与无报警信号组相比，有 1、2、3 和≥4 个报警信号的患者的医院死亡率分别增加了 2.79、2.76、6.54 和 20.02 倍。
研究发现，术后医院死亡率增加与 RRS 在 POD 0-3 期间检测到的报警信号有关。因此，RRS 检测到的术后报警信号可能有助于确定需要在外科病房进行医疗干预的高危患者。
