scholarly journals Rapid Response Team activation after major hip surgery: patient characteristics and outcomes

2021 ◽  
Author(s):  
Angus Pritchard ◽  
Daryl Jones ◽  
Rinaldo Bellomo ◽  
Andrew Hardidge ◽  
Ian Harley ◽  
...  
Keyword(s):  
A Priori ◽  
Rapid Response Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
Interquartile Range ◽  
University Teaching ◽  
Hip Surgery ◽  
Surgery Patient ◽  
High Dependency ◽  
Index Hospital

Abstract Background: Rapid response teams (RRTs) are a critical care resource that review deteriorating patients within the hospital. We aimed to describe demographic, preoperative, surgical, anesthetic, and postoperative characteristics of patients who required RRT activation after major hip surgery. We also sought to assess whether these characteristics where associated with mortality during the index hospital admission.Methods: We reviewed an RRT database of adult patients undergoing orthopedic surgery at a university teaching hospital. We then retrospectively reviewed the medical records to extract a priori–defined patient, preoperative, surgical, anesthetic, and postoperative data of major hip surgery admissions between September 2014 and December 2017. Patients who survived the index hospital stay were compared to those who died.Results: Overall, 187 patients had postoperative RRT activations. Median (interquartile range) age was 84.0 (78-90) years; 125 (67%) were female, and most patients had at least one significant comorbidity, median Charlson Comorbidity Index (CCI) 5.0 (4.0-7.0). The majority of patients were frail (68%), American Society of Anesthesiologists physical status Class 3 or greater (91%), and underwent nonelective surgery (88%). Median (interquartile range) time from surgery to RRT activation was 29.4 (11.3–75.0) hours, and 25 (13%) patients had unplanned admissions to intensive care or high dependency units. Compared to patients who survived RRT activation, those who died displayed higher mean CCI (6.5 [1.8] vs. 5.5 [2.1], p = 0.02), were more frail (80.1% vs. 56.5%, OR = 3.2, 95% CI: 1.2,8.1; p = 0.03), and received less intraoperative opioids (intravenous morphine equi-analgesia: median = 5.8 (0.1–8.20 vs. 11.7 (3.7–19.0) mg, p = 0.03). They were also more likely to have received an urgent medical review prior to RRT activation (62% vs. 40%, OR = 2.4, 95% CI: 1.1, 5.6); p = 0.05.Conclusions: Death after RRT activation occurred in 1 in 7 patients undergoing major hip surgery. Common patient characteristics included advanced age (> 82 years), frailty, high CCI, and emergency surgery. Further studies investigating perioperative surveillance teams in the identification of the high-risk patients before surgery and deteriorating patients after major hip surgery are warranted.

scholarly journals Rapid Response Team activation after major hip surgery: patient characteristics and outcomes

2020 ◽  
Author(s):  
Angus Pritchard ◽  
Daryl Jones ◽  
Rinaldo Bellomo ◽  
Andrew Hardidge ◽  
Ian Harley ◽  
...  
Keyword(s):  
A Priori ◽  
Rapid Response Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
Interquartile Range ◽  
University Teaching ◽  
Hip Surgery ◽  
Surgery Patient ◽  
High Dependency ◽  
Index Hospital

Abstract Background: Rapid response teams (RRTs) are a critical care resource that review deteriorating patients within the hospital. We aimed to describe demographic, preoperative, surgical, anesthetic, and postoperative characteristics of patients who required RRT activation after major hip surgery. We also sought to assess whether these characteristics where associated with mortality during the index hospital admission.Methods: We reviewed an RRT database of adult patients undergoing orthopedic surgery at a university teaching hospital. We then retrospectively reviewed the medical records to extract a priori–defined patient, preoperative, surgical, anesthetic, and postoperative data of major hip surgery admissions between September 2014 and December 2017. Patients who survived the index hospital stay were compared to those who died.Results: Overall, 187 patients had postoperative RRT activations. Median (interquartile range) age was 84.0 (78-90) years; 125 (67%) were female, and most patients had at least one significant comorbidity, median Charlson Comorbidity Index (CCI) 5.0 (4.0-7.0). The majority of patients were frail (68%), American Society of Anesthesiologists physical status Class 3 or greater (91%), and underwent nonelective surgery (88%). Median (interquartile range) time from surgery to RRT activation was 29.4 (11.3–75.0) hours, and 25 (13%) patients had unplanned admissions to intensive care or high dependency units. Compared to patients who survived RRT activation, those who died displayed higher mean CCI (6.5 [1.8] vs. 5.5 [2.1], p = 0.02), were more frail (80.1% vs. 56.5%, OR = 3.2, 95% CI: 1.2,8.1; p = 0.03), and received less intraoperative opioids (intravenous morphine equi-analgesia: median = 5.8 (0.1–8.20 vs. 11.7 (3.7–19.0) mg, p = 0.03). They were also more likely to have received an urgent medical review prior to RRT activation (62% vs. 40%, OR = 2.4, 95% CI: 1.1, 5.6); p = 0.05.Conclusions: Death after RRT activation occurred in 1 in 7 patients undergoing major hip surgery. Common patient characteristics included advanced age (> 82 years), frailty, high CCI, and emergency surgery. Further studies investigating perioperative surveillance teams in the identification of the high-risk patients before surgery and deteriorating patients after major hip surgery are warranted.

scholarly journals Rapid Response Team Activation After Major Hip Surgery: Patient Characteristics and Outcomes

2020 ◽  
Author(s):  
Angus Pritchard ◽  
Daryl Jones ◽  
Rinaldo Bellomo ◽  
Andrew Hardidge ◽  
Ian Harley ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Elective Surgery ◽  
A Priori ◽  
Rapid Response Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
University Teaching ◽  
Hip Surgery ◽  
Surgery Patient ◽  
Index Hospital

Abstract Background: Rapid Response Teams (RRT) are a critical care resource that reviews deteriorating patients within the hospital. Whilst contemporary literature has focused on outcomes of RRTs, little is known about the detailed perioperative course and characteristics of patients who require RRT activation after major hip surgery. We aimed to describe demographic, preoperative, surgical, anesthetic and postoperative characteristics of patients who required RRT activation after major hip surgery. We also sought to assess if these characteristics affected mortality during the index hospital admission. Methods: We reviewed a RRT database of adult patients undergoing orthopedic surgery at a university teaching hospital. We then retrospectively reviewed the medical records to extract a priori defined patient, preoperative, surgical, anesthetic and postoperative data of major hip surgery admissions between September 2014 and December 2017. Patients who survived the index hospital stay were compared to those who died.Results: Overall, 187 patients had a postoperative RRT activations. Mean (SD) age was 82.1 (11.6) years; 125 (67%) were female and most patients had at least one significant comorbidity: mean (SD) Charlson Comorbidity Index (CCI) of 5.6 (2.1). The majority of patients (68%) were frail, ASA class 3 or greater (91%) and underwent non-elective surgery (88%). Median (IQR) time from surgery to RRT activation was 29.4 hours (11.3:75.0), and 25 (13%) patients had unplanned admissions to ICU/HDU. Compared to patients who survived RRT activation, those who died displayed higher CCI [6.5 (1.8) vs. 5.5 (2.1); p=0.02], were more frail (80.1% vs. 56.5%; odds ratio 3.2; 95%CI: 1.2 to 8.1; p=0.03) and received less intraoperative opioids [median (IQR) intravenous morphine equi-analgesia 5.8 (0.1:8.2) mg vs. 11.7 (3.7:19.0) mg; p=0.03]. They were also more likely to receive an urgent medical review prior to RRT activation (62% vs 40%; odds ratio 2.4; 95%CI: 1.1 to 5.6; p=0.05).Conclusions: Death after RRT activation occurred in 1 out of 7 patients undergoing major hip surgery. Common patient characteristics included advanced age (>82 years), frailty, high CCI and emergency surgery. Further studies investigating perioperative surveillance teams in the identification of the high-risk patients before surgery, and deteriorating patients after major hip surgery, are warranted.

Derivation and validation of a risk score for predicting mortality among inpatients following rapid response team activation

2019 ◽  
Vol 95 (1124) ◽  
pp. 300-306
Author(s):  
Kyle White ◽  
Anne Bernard ◽  
Ian Scott
Keyword(s):  
Risk Prediction ◽  
Risk Score ◽  
Positive Likelihood Ratio ◽  
Emergency Admission ◽  
Rapid Response Team ◽  
Patient Characteristics ◽  
Rapid Response ◽  
Early Warning Score ◽  
Hospitalised Patients ◽  
Response Team

Purpose of the studyDespite mature rapid response systems (RRS) for clinical deterioration, individuals activating RRS have poor outcomes, with up to one in four dying in hospital. We aimed to derive and validate a risk prediction tool for estimating risk of 28-day mortality among hospitalised patients following rapid response team (RRT) activation.Study designAnalysis of prospectively collected data on 1151 consecutive RRT activations involving 800 inpatients at a tertiary adult hospital. Patient characteristics, RRT triggers and actions, and mortality were ascertained from medical records and death registries. A multivariable risk prediction regression model, derived from 600 randomly selected patients, was validated in the remaining 200 patients. Main outcome was accuracy of weighted risk score (measured by area under receiver operator curve (AUC)) and performance characteristics for various cut-off scores.ResultsAt 28 days, 150 (18.8%) patients had died. Increasing age, emergency admission, chronic liver disease, chronic kidney disease, malignancy, after-hours RRT activation, increasing National Early Warning Score, major/intense RRT intervention and multiple RRT activations were predictors of mortality. The risk score (0–105) in derivation and validation cohorts had AUCs 0.86 (95% CI 0.82 to 0.89) and 0.82 (95% CI 0.75 to 0.90), respectively. In the validation cohort, cut-off score of 32.5 or higher maximised sensitivity: 81.6% (95% CI 68.4% to 92.1%), specificity: 56.2% (95% CI 49.4% to 63.6%), positive likelihood ratio (LR): 1.9 (95% CI 1.5 to 2.3) and negative LR: 0.3 (95% CI 0.2 to 0.6).ConclusionA validated risk score predicted risk of post-RRT death with more than 80% accuracy, helping to identify patients for whom targeted rescue care may improve survival.

scholarly journals Rapid response team activation after major hip surgery: A case series

2021 ◽  
pp. 106699
Author(s):  
Laurence Weinberg ◽  
Angus Pritchard ◽  
Maleck Louis ◽  
Daryl Jones ◽  
Andrew Hardidge ◽  
...  
Keyword(s):  
Case Series ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Hip Surgery ◽  
Response Team

Mise en place et organisation d’une équipe médicale mobile de réponse précoce aux urgences intra-hospitalières (Rapid Response Team)

2020 ◽  
Author(s):  
Boris Jung ◽  
Gerald Chanques ◽  
Samir Jaber ◽  
Kada Klouche
Keyword(s):  
Rapid Response Team ◽  
Rapid Response ◽  
Prise En Charge ◽  
Response Team

La mise en place d’une Rapid Response Team a pour objectif la mise en place d’une structure de réponse hospitalièrepour la prise en charge des urgences vitales et surtout une réponse précoce à la dégradation clinique des patientshospitalisés avant que l’urgence vitale ne survienne. Nous discutons dans ce manuscrit le rationnel et le niveau depreuve motivant la mise en place d’une Rapid Response Team ainsi que les freins qui doivent être surmontés pour lesuccès de cette mise en place.

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