Characteristics and outcomes of Rapid Response Team activations for hypotension in orthopaedic patients.

Abstract

Hypotension following orthopaedic surgery has been associated with increased morbidity and mortality. Rapid Response Teams (RRTs) review patients on hospital wards with hypotension. To evaluate the epidemiology of hypotensive RRT activations in adult orthopaedic patients to identify contributing factors, and areas for future quality improvement. Retrospective observational study using data from RRT and clinical informatics databases. Evaluation of timing, presumed causes of hypotension and associated treatments. Amongst 963 RRT activations in 605 patients over three years, 226/605 (37.4%) of first calls were due to hypotension and 213/226 (94.2%) had sufficient data for analysis. The median age was 79 (IQR 66-87) years, 58 (27.2%) were male, and co-morbidities were common. Most (68%) surgery was emergent and 75.1% received intra-operative vasopressors for hypotension. Most activations occurred within 24 hours of surgery, and hypovolemia, infection and arrhythmias were common presumed causes. Fluid boluses occurred in 173 (81.2%), and the time between surgery and RRT activation was 10 (4.0-26.5) hr in cases where fluid boluses were given, compared with 33 (15.5-61.5) hr where they were not (p< 0.001). Blood transfusion (30, 14.1%) and withholding of medications were also common. Hospital mortality was 8.5% (18), and 13.6% (29) were admitted to critical care at some stage. In hospital death was associated with older age, functional dependence, arrhythmia and presumed infection. Hypotension-related RRT calls in orthopaedic patients are common. Future interventional studies might focus on peri-operative fluid therapy and vaso-active medications, as well as withholding of anti-hypertensive medications pre-operatively. This article is protected by copyright. All rights reserved.