The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.

<h4>Background</h4>Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model)...

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Autores principales:	Claudia de Souza Gutierrez, Katia Bottega, Stela Maris de Jezus Castro, Gabriela Leal Gravina, Eduardo Kohls Toralles, Otávio Ritter Silveira Martins, Wolnei Caumo, Luciana Cadore Stefani
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1644f06061e548e097861581d778b4bd
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spelling	oai:doaj.org-article:1644f06061e548e097861581d778b4bd2021-12-02T20:13:11ZThe impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.1932-620310.1371/journal.pone.0257941https://doaj.org/article/1644f06061e548e097861581d778b4bd2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257941https://doaj.org/toc/1932-6203<h4>Background</h4>Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients.<h4>Methods</h4>A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission.<h4>Results</h4>Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death.<h4>Conclusion</h4>Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.Claudia de Souza GutierrezKatia BottegaStela Maris de Jezus CastroGabriela Leal GravinaEduardo Kohls TorallesOtávio Ritter Silveira MartinsWolnei CaumoLuciana Cadore StefaniPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0257941 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Claudia de Souza Gutierrez Katia Bottega Stela Maris de Jezus Castro Gabriela Leal Gravina Eduardo Kohls Toralles Otávio Ritter Silveira Martins Wolnei Caumo Luciana Cadore Stefani The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.
description	<h4>Background</h4>Practical use of risk predictive tools and the assessment of their impact on outcome reduction is still a challenge. This pragmatic study of quality improvement (QI) describes the preoperative adoption of a customised postoperative death probability model (SAMPE model) and the evaluation of the impact of a Postoperative Anaesthetic Care Unit (PACU) pathway on the clinical deterioration of high-risk surgical patients.<h4>Methods</h4>A prospective cohort of 2,533 surgical patients compared with 2,820 historical controls after the adoption of a quality improvement (QI) intervention. We carried out quick postoperative high-risk pathways at PACU when the probability of postoperative death exceeded 5%. As outcome measures, we used the number of rapid response team (RRT) calls within 7 and 30 postoperative days, in-hospital mortality, and non-planned Intensive Care Unit (ICU) admission.<h4>Results</h4>Not only did the QI succeed in the implementation of a customised risk stratification model, but it also diminished the postoperative deterioration evaluated by RRT calls on very high-risk patients within 30 postoperative days (from 23% before to 14% after the intervention, p = 0.05). We achieved no survival benefits or reduction of non-planned ICU. The small group of high-risk patients (13% of the total) accounted for the highest proportion of RRT calls and postoperative death.<h4>Conclusion</h4>Employing a risk predictive tool to guide immediate postoperative care may influence postoperative deterioration. It encouraged the design of pragmatic trials focused on feasible, low-technology, and long-term interventions that can be adapted to diverse health systems, especially those that demand more accurate decision making and ask for full engagement in the control of postoperative morbi-mortality.
format	article
author	Claudia de Souza Gutierrez Katia Bottega Stela Maris de Jezus Castro Gabriela Leal Gravina Eduardo Kohls Toralles Otávio Ritter Silveira Martins Wolnei Caumo Luciana Cadore Stefani
author_facet	Claudia de Souza Gutierrez Katia Bottega Stela Maris de Jezus Castro Gabriela Leal Gravina Eduardo Kohls Toralles Otávio Ritter Silveira Martins Wolnei Caumo Luciana Cadore Stefani
author_sort	Claudia de Souza Gutierrez
title	The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.
title_short	The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.
title_full	The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.
title_fullStr	The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.
title_full_unstemmed	The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.
title_sort	impact of the incorporation of a feasible postoperative mortality model at the post-anaesthestic care unit (pacu) on postoperative clinical deterioration: a pragmatic trial with 5,353 patients.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/1644f06061e548e097861581d778b4bd
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The impact of the incorporation of a feasible postoperative mortality model at the Post-Anaesthestic Care Unit (PACU) on postoperative clinical deterioration: A pragmatic trial with 5,353 patients.

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