Interdepartment of Critical Care Medicine, Department of Anesthesiology and Pain medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Injury. 2021 Jul;52(7):1841-1845. doi: 10.1016/j.injury.2021.04.029. Epub 2021 Apr 9.
Even with preoperative screening and medical preparation, elderly hip fracture surgery (HFS) patients may have serious events including cardiopulmonary arrest (CPA) and death during the perioperative period. The rapid response system (RRS) that responds early to changes in the condition of patients is helping to improve the survival rate. To date, there have been no studies on the effectiveness of rapid response system in HFS patients.
In October 2012, our institution, a tertiary referral hospital, implemented an RRS. The system activated in heart rate <40/min or >140/min, systolic blood pressure <80mmHg, respiratory rate <10/min or >30/min, oxygen saturation <90%, sudden change in the level of consciousness, and seizure. We conducted before-and-after study using electronic medical records of patients older than 60 years, who underwent surgery during before implemented period (May 2003 to September 2012) and during after implemented period (October 2013 to December 2018). 1,483 pre-RRS patients and 1,315 post-RRS patients were enrolled in this study. We aimed to evaluate the effect of implementing the RRS on the management of patients undergoing HFS. We analysis 1) interval between the detection of abnormal vital sign and notification to attending physician; 2) interval between the detection of abnormal vital sign and adequate intervention; 3) incidence of CPA, 4) admission to intensive care unit 5) unexpected death; 6) duration of hospital stay; and 7) survival rate.
The interval between the detection of abnormal vital sign and notification to attending physician decreased from 23.9(±28.1) minutes to 11.4(±11.02) minutes (p<0.001). The interval between the detection of abnormal vital sign and intervention by the attending physician decreased from 67.3(±40.3) minutes to 15.8(±10.9) minutes (p<0.001). There were no significant differences in unexpected admission to intensive care unit (32/50 versus 20/88, p = 0.213) and in-hospital death (15 versus 16, p = 0.605) between the two groups. The duration of hospitalization decreased from 24.9 days to 15.4 days (p < 0.001). The 5-year survival rate was 57% in the pre-RRS group and 72% in the post-RRS group (hazard ratio = 0.73; 95% confidence interval = 0.61-0.87, p < 0.001).
Implementation of RRS rendered early notification and prompt intervention of deteriorating patients undergoing HFS and reduced the duration of hospital stay.
即使进行了术前筛查和医学准备，老年髋部骨折手术（HFS）患者在围手术期仍可能发生严重事件，包括心肺骤停（CPA）和死亡。快速反应系统（RRS）可早期应对患者病情变化，有助于提高生存率。迄今为止，尚无研究报道 RRS 在 HFS 患者中的有效性。
2012 年 10 月，我们机构（一家三级转诊医院）实施了 RRS。该系统在心率<40/min 或>140/min、收缩压<80mmHg、呼吸频率<10/min 或>30/min、氧饱和度<90%、意识水平突然改变和癫痫发作时启动。我们使用 2003 年 5 月至 2012 年 9 月期间实施前阶段和 2013 年 10 月至 2018 年 12 月期间实施后阶段接受手术的 60 岁以上患者的电子病历进行了前后研究。本研究共纳入了 1483 例前 RRS 患者和 1315 例后 RRS 患者。我们旨在评估实施 RRS 对接受 HFS 治疗的患者管理的影响。我们分析了 1）异常生命体征检测与通知主治医生之间的时间间隔；2）异常生命体征检测与充分干预之间的时间间隔；3）CPA 发生率；4）入住重症监护病房；5）意外死亡；6）住院时间；7）生存率。
异常生命体征检测与通知主治医生之间的时间间隔从 23.9(±28.1)分钟缩短至 11.4(±11.02)分钟（p<0.001）。异常生命体征检测与主治医生干预之间的时间间隔从 67.3(±40.3)分钟缩短至 15.8(±10.9)分钟（p<0.001）。两组间意外入住重症监护病房（32/50 与 20/88，p=0.213）和院内死亡（15 与 16，p=0.605）无显著差异。住院时间从 24.9 天缩短至 15.4 天（p<0.001）。前 RRS 组的 5 年生存率为 57%，后 RRS 组为 72%（风险比=0.73；95%置信区间=0.61-0.87，p<0.001）。
实施 RRS 可及时通知并迅速干预病情恶化的 HFS 患者，并缩短住院时间。
