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The epidemiology of rapid response team activation amongst patients undergoing major gastrointestinal surgery

  • Author Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    Alexander LM. Pritchard
    Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    Affiliations
    Austin Health, Melbourne, Australia

    School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
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  • Author Footnotes
    k Melbourne Medical School, Ground Floor, Medical Building, Cnr Grattan Street & Royal Parade, University of Melbourne Victoria, Australia 3010.
    Ken Lee Chin
    Footnotes
    k Melbourne Medical School, Ground Floor, Medical Building, Cnr Grattan Street & Royal Parade, University of Melbourne Victoria, Australia 3010.
    Affiliations
    Melbourne Medical School, The University of Melbourne, Melbourne, Australia

    CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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  • Author Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    David A. Story
    Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    Affiliations
    Austin Health, Melbourne, Australia

    Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia

    Melbourne Academic Centre for Health, Melbourne, Australia
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  • Author Footnotes
    l Colorectal Surgery, Austin Health, PO BOX 5555, Heidelberg, Victoria, 3084.
    Phil Smart
    Footnotes
    l Colorectal Surgery, Austin Health, PO BOX 5555, Heidelberg, Victoria, 3084.
    Affiliations
    Austin Health, Melbourne, Australia

    General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Australia
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  • Author Footnotes
    m Intensive Care Unit, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084
    Daryl A. Jones
    Correspondence
    Corresponding author at: Austin Health and Warringal hospital, Australia.
    Footnotes
    m Intensive Care Unit, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084
    Affiliations
    Austin Health, Melbourne, Australia

    School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia

    Department of Surgery, The University of Melbourne, Australia
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  • Author Footnotes
    m Intensive Care Unit, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084
    Emily See
    Footnotes
    m Intensive Care Unit, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084
    Affiliations
    Austin Health, Melbourne, Australia

    Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia

    Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
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  • Author Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    Justin M. Nazareth
    Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    Affiliations
    Austin Health, Melbourne, Australia

    Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia

    Department of Surgery, The University of Melbourne, Australia
    Search for articles by this author
  • Author Footnotes
    j Department of Anaesthesia, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084.
    k Melbourne Medical School, Ground Floor, Medical Building, Cnr Grattan Street & Royal Parade, University of Melbourne Victoria, Australia 3010.
    l Colorectal Surgery, Austin Health, PO BOX 5555, Heidelberg, Victoria, 3084.
    m Intensive Care Unit, Austin Health, Level 2, Austin Hospital, 145 Studley Road, Heidelberg, Victoria, Australia 3084

      Abstract

      Background

      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.

      Objectives

      The objective of this study is to identify perioperative risks and outcome associations with RRT review following major gastrointestinal surgery.

      Methods

      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.

      Results

      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.

      Conclusion

      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.

      Keywords

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