Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30247
Title: The epidemiology of rapid response team activation amongst patients undergoing major gastrointestinal surgery.
Austin Authors: Pritchard, Alexander Lm;Chin, Ken Lee;Story, David A ;Smart, Philip J ;Jones, Daryl A ;See, Emily J ;Nazareth, Justin M
Affiliation: Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia..
Austin Health
School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia..
Melbourne Medical School, The University of Melbourne, Melbourne, Australia..
CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia..
Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia..
Melbourne Academic Centre for Health, Melbourne, Australia..
General Surgery and Gastroenterology Clinical Institute, Epworth Healthcare, Melbourne, Australia..
Department of Surgery, The University of Melbourne, Australia..
Issue Date: 22-May-2022
Date: 2022
Publication information: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses 2022; online first: 22 May
Abstract: 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. The objective of this study is to identify perioperative risks and outcome associations with RRT review following major gastrointestinal surgery. 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. 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. 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.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30247
DOI: 10.1016/j.aucc.2022.04.003
ORCID: 0000-0002-6479-1310
0000-0002-3313-7092
0000-0002-6446-3595
0000-0003-4436-4319
0000-0002-9678-5206
Journal: Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses
PubMed URL: 35613982
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/35613982/
ISSN: 1036-7314
Type: Journal Article
Subjects: Clinical deterioration
Failure to rescue
Medical emergency team
Postoperative complication
Rapid response team
Appears in Collections:Journal articles

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