Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/33484
Title: Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes.
Austin Authors: Bain, C R;Myles, P S;Martin, C;Wallace, S;Shulman, M A;Corcoran, T;Bellomo, R;Peyton, P;Story, D A;Leslie, K;Forbes, A
Affiliation: Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia.
Department of Anaesthesiology and Peri-operative Medicine, Alfred Hospital and Monash University, Melbourne, VIC, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA, Australia.
Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.;Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Anaesthesia
Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, VIC, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Issue Date: Nov-2023
Date: 2023
Publication information: Anaesthesia 2023-11; 78(11)
Abstract: Postoperative systemic inflammation is strongly associated with surgical outcomes, but its relationship with patient-centred outcomes is largely unknown. Detection of excessive inflammation and patient and surgical factors associated with adverse patient-centred outcomes should inform preventative treatment options to be evaluated in clinical trials and current clinical care. This retrospective cohort study analysed prospectively collected data from 3000 high-risk, elective, major abdominal surgery patients in the restrictive vs. liberal fluid therapy for major abdominal surgery (RELIEF) trial from 47 centres in seven countries from May 2013 to September 2016. The co-primary endpoints were persistent disability or death up to 90 days after surgery, and quality of recovery using a 15-item quality of recovery score at days 3 and 30. Secondary endpoints included: 90-day and 1-year all-cause mortality; septic complications; acute kidney injury; unplanned admission to intensive care/high dependency unit; and total intensive care unit and hospital stays. Patients were assigned into quartiles of maximum postoperative C-reactive protein concentration up to day 3, after multiple imputations of missing values. The lowest (reference) group, quartile 1, C-reactive protein ≤ 85 mg.l-1 , was compared with three inflammation groups: quartile 2 > 85 mg.l-1 to 140 mg.l-1 ; quartile 3 > 140 mg.l-1 to 200 mg.l-1 ; and quartile 4 > 200 mg.l-1 to 587 mg.l-1 . Greater postoperative systemic inflammation had a higher adjusted risk ratio (95%CI) of persistent disability or death up to 90 days after surgery, quartile 4 vs. quartile 1 being 1.76 (1.31-2.36), p < 0.001. Increased inflammation was associated with increasing decline in risk-adjusted estimated medians (95%CI) for quality of recovery, the quartile 4 to quartile 1 difference being -14.4 (-17.38 to -10.71), p < 0.001 on day 3, and -5.94 (-8.92 to -2.95), p < 0.001 on day 30. Marked postoperative systemic inflammation was associated with increased risk of complications, poor quality of recovery and persistent disability or death up to 90 days after surgery.
URI: https://ahro.austin.org.au/austinjspui/handle/1/33484
DOI: 10.1111/anae.16104
ORCID: 0000-0002-3142-5410
Journal: Anaesthesia
PubMed URL: 37531295
ISSN: 1365-2044
Type: Journal Article
Subjects: anaesthesia
disability-free survival
major surgery
patient-reported outcomes
quality of recovery
systemic inflammation
Appears in Collections:Journal articles

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