Homsy Michele, Dale-Gandar Julius, Schwarz Stephan K W, Flexman Alana M, MacDonell Su-Yin
Department of Anesthesia, St. Paul's Hospital/Providence Health Care, Vancouver, BC, Canada.
Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
Can J Anaesth. 2024 Dec;71(12):1653-1663. doi: 10.1007/s12630-024-02884-1. Epub 2024 Dec 20.
Approximately 320 million surgeries occur annually worldwide, increasingly performed on an ageing, comorbid population in whom postoperative complications contribute significantly to mortality. While anesthesiologists have led advances in perioperative care, the optimal structure of the provision of postoperative care has lacked discourse. In this article, we describe the implementation, structure, role, and benefits of an Anesthesiology Perioperative Outreach Service (APOS) at a Canadian tertiary hospital, providing proactive daily review and management of high-risk surgical patients. The APOS involves routine reviews and care on surgical wards, emphasizing collaboration among anesthesiology, internal medicine, surgery, and geriatric medicine teams, with a specific screening pathway to identify patients experiencing myocardial injury after noncardiac surgery. We discuss case vignettes to illustrate common examples of how the APOS enabled early detection and treatment escalation for deteriorating patients and provide a focused narrative literature review. The anesthesiology-led perioperative outreach model described herein could provide an implementable framework for institutions seeking to enhance their quality of postoperative care-particularly among complex, comorbid patients at risk of postoperative morbidity.
全球每年约有3.2亿台手术，越来越多的手术是在老龄化、患有多种疾病的人群中进行的，术后并发症在这些人群的死亡率中占很大比例。虽然麻醉医生在围手术期护理方面取得了进展，但术后护理提供的最佳结构却缺乏相关讨论。在本文中，我们描述了加拿大一家三级医院的麻醉科围手术期外展服务（APOS）的实施、结构、作用和益处，该服务为高危手术患者提供主动的每日复查和管理。APOS包括在外科病房进行常规复查和护理，强调麻醉科、内科、外科和老年医学团队之间的协作，并通过特定的筛查途径识别非心脏手术后发生心肌损伤的患者。我们讨论病例 vignettes 以说明APOS如何为病情恶化的患者实现早期检测和治疗升级的常见例子，并提供重点文献综述。本文所述的由麻醉科主导的围手术期外展模式可为寻求提高术后护理质量的机构提供一个可实施的框架，特别是在有术后发病风险的复杂、合并症患者中。
