Austin Health, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia.
Melbourne Medical School, The University of Melbourne, Melbourne, Australia; CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Aust Crit Care. 2023 Jul;36(4):542-549. doi: 10.1016/j.aucc.2022.04.003. Epub 2022 May 22.
Clinical deterioration requiring rapid response team (RRT) review is associated with increased morbidity amongst hospitalised patients. The frequency of and association with RRT calls in patients undergoing major gastrointestinal surgery is unknown. Understanding the epidemiology of RRT calls might identify areas for quality improvement in this cohort.
The objective of this study is to identify perioperative risks and outcome associations with RRT review following major gastrointestinal surgery.
We conducted a retrospective cohort study using electronic databases at a large Australian university hospital. We included adult patients admitted for major gastrointestinal surgery between 1 January 2015 and 31 March 2018.
Of 7158 patients, 514 (7.4%) required RRT activation postoperatively. After adjustment, variables associated with RRT activation included the following: hemiplegia/paraplegia (odds ratio [OR]: 8.0, 95% confidence interval [CI]: 2.3 to 27.8, p = 0.001), heart failure (OR: 6.9, 95% CI: 3.3 to 14.6, p < 0.001), peripheral vascular disease (OR: 5.3, 95% CI: 2.7 to 10.4, p < 0.001), peptic ulcer disease (OR: 4.2, 95% CI: 2.2 to 8.0, p < 0.001), chronic obstructive pulmonary disease (OR: 4.0, 95% CI: 2.2 to 7.2, p < 0.001), and emergency admission status (OR: 2.6, 95% CI: 2.1 to 3.3, p < 0.001). Following the index operation, 46% of first RRT activations occurred within 24 h of surgery and 61% had occurred within 48 h. The most common triggers for RRT activation were tachycardia, hypotension, and tachypnoea. Postoperative RRT activation was associated with in-hospital mortality (OR: 6.7, 95% CI: 3.8 to 11.8, p < 0.001), critical care admission (incidence rate ratio: 8.18, 95% CI: 5.23 to 12.77, p < 0.001), and longer median length of hospital stay (12 days vs. 2 days, p < 0.001) compared to no RRT activation.
After major gastrointestinal surgery, one in 14 patients had an RRT activation, almost half within 24 h of surgery. Such activation was independently associated with increased morbidity and mortality. Identified associations may guide more pre-emptive management for those at an increased risk of RRT activation.
需要快速反应团队（RRT）审查的临床恶化与住院患者的发病率增加有关。在接受重大胃肠道手术的患者中，RRT 呼叫的频率和关联尚不清楚。了解 RRT 呼叫的流行病学情况可能会确定该队列中质量改进的领域。
本研究的目的是确定围手术期风险和 RRT 审查结果与重大胃肠道手术后的关系。
我们使用澳大利亚一家大型大学医院的电子数据库进行了回顾性队列研究。我们纳入了 2015 年 1 月 1 日至 2018 年 3 月 31 日期间因重大胃肠道手术入院的成年患者。
在 7158 名患者中，514 名（7.4%）术后需要 RRT 激活。调整后，与 RRT 激活相关的变量包括以下内容：偏瘫/截瘫（比值比 [OR]：8.0，95%置信区间 [CI]：2.3 至 27.8，p = 0.001）、心力衰竭（OR：6.9，95%CI：3.3 至 14.6，p < 0.001）、外周血管疾病（OR：5.3，95%CI：2.7 至 10.4，p < 0.001）、消化性溃疡病（OR：4.2，95%CI：2.2 至 8.0，p < 0.001）、慢性阻塞性肺疾病（OR：4.0，95%CI：2.2 至 7.2，p < 0.001）和紧急入院状态（OR：2.6，95%CI：2.1 至 3.3，p < 0.001）。在索引手术后，首次 RRT 激活的 46%发生在手术 24 小时内，61%发生在手术 48 小时内。RRT 激活的最常见触发因素是心动过速、低血压和呼吸急促。术后 RRT 激活与院内死亡率（OR：6.7，95%CI：3.8 至 11.8，p < 0.001）、重症监护病房入院（发病率比：8.18，95%CI：5.23 至 12.77，p < 0.001）和住院时间中位数延长（12 天与 2 天，p < 0.001）相关，而与无 RRT 激活相比。
在接受重大胃肠道手术后，每 14 名患者中就有 1 名患者需要进行 RRT 激活，近一半患者在手术后 24 小时内进行。这种激活与发病率和死亡率的增加独立相关。确定的关联可能为那些 RRT 激活风险增加的患者提供更具前瞻性的管理指导。
