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    Acute Risk Change: An Innovative Measure of Operative Adverse Events and Perioperative Team Performance

    Access Status
    Fulltext not available
    Authors
    Coulson, T.
    Gregson, B.
    Sandys, S.
    Nashef, S.
    Webb, S.
    Bailey, M.
    Reid, Christopher
    Pilcher, D.
    Date
    2018
    Type
    Journal Article
    
    Metadata
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    Citation
    Coulson, T. and Gregson, B. and Sandys, S. and Nashef, S. and Webb, S. and Bailey, M. and Reid, C. et al. 2018. Acute Risk Change: An Innovative Measure of Operative Adverse Events and Perioperative Team Performance. Journal of Cardiothoracic and Vascular Anesthesia. 32 (5): pp. 2160-2166.
    Source Title
    Journal of Cardiothoracic and Vascular Anesthesia
    DOI
    10.1053/j.jvca.2018.01.014
    ISSN
    1053-0770
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/68035
    Collection
    • Curtin Research Publications
    Abstract

    Objectives: Cardiac surgical risk models predict mortality preoperatively, whereas intensive care unit (ICU) models predict mortality postoperatively. Finding a large difference between the 2 (an acute risk change [ARC]) may reflect an alteration in the status of the patient related to the surgery. An adverse ARC was associated with morbidity and mortality in an Australian population. The aims of this study were to validate ARC in a UK population and to investigate the possible mechanisms behind ARC. Design: This was a retrospective case-control study. Setting: Single, high-volume cardiothoracic hospital. Participants: Data from 4,842 cardiac surgical patients were collected between 2013 and 2015. Interventions: None. Measurements and main results: EuroSCORE was recalibrated to each preceding year's data. ARC was defined as postoperative minus preoperative percentage mortality risk. Association among ARC, morbidity, and mortality was tested. Cases with large adverse ARC (greater than +15%) were compared with cases with large favorable ARC (less than -10%) with regard to intraoperative adverse events, unmeasured patient risk factors, and postoperative events. Adverse ARC was associated with hospital mortality, ICU stay, ICU readmission, renal support, prolonged intubation and return to the operating room (p < 0.001). Intraoperative adverse events occurred in 23 of 33 patients with adverse ARC; however, only 2 of 17 patients with favorable ARC reported adverse events (p < 0.001). Unmeasured risk factors were present in 48% of patients in the adverse ARC group. Conclusion: ARC is a readily available and sensitive marker that correlates strongly with morbidity and mortality. The use of ARC in local and national quality monitoring could identify areas for improvement of the quality of cardiac surgical care.

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