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Colt Cowdell J, Lopez E, Haney A, Myers L, Coble B, Heckman MG, Moerer RT, Paulson MR, Maniaci M. Risk factors associated with escalation of care in a quaternary academic hospital at home program. J Hosp Med 2024. [PMID: 38797937 DOI: 10.1002/jhm.13411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 05/02/2024] [Accepted: 05/07/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Hospital-at-home has become a more recognized way to care for patients requiring inpatient hospitalization. At times, these patients may require escalation of care (transfer from home back to the brick-and mortar (BAM) hospital for ongoing hospitalization care needs), a process that has not been extensively studied. OBJECTIVE To evaluate what patient factors contribute to escalations of care in the hospital-at-home delivery model. DESIGNS, SETTINGS, AND PARTICIPANTS We conducted a retrospective review of all patients admitted to Mayo Clinic's Advanced Care at Home (ACH) program from January 1, 2022 to December 31, 2022. INTERVENTION None. MAIN OUTCOMES AND MEASURES Patient information was collected via electronic health record including demographic, socioeconomic, and clinical status. The primary outcome was the of occurrence of an escalation. RESULTS A total of 904 patients were included, of whom 80 (8.8%) required an escalation of care. In multivariable analysis, risk of an escalation was significantly higher for patients who were married or had a life partner (HR: 1.82, 95% CI: 1.05-3.23, p = .033) for patients admitted with procedure-related disorders (HR: 2.61, 95% CI: 1.35-5.05, p = .005) and patients with an increased mortality risk score (HR [per each 1-category increase] = 1.86, 95% CI: 1.39-2.50, p < .001).
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Affiliation(s)
- Jed Colt Cowdell
- Division of Hospital Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Ellen Lopez
- Division of Advanced Care at Home, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Amy Haney
- Division of Advanced Care at Home, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Luke Myers
- Division of Advanced Care at Home, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Barbara Coble
- Division of Advanced Care at Home, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Michael G Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Ryan T Moerer
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Jacksonville, Florida, USA
| | - Michael Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida, USA
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Wells CI, Bhat S, Xu W, Varghese C, Keane C, Baraza W, O'Grady G, Harmston C, Bissett IP. Variation in the definition of 'failure to rescue' from postoperative complications: a systematic review and recommendations for outcome reporting. Surgery 2024; 175:1103-1110. [PMID: 38245447 DOI: 10.1016/j.surg.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 11/14/2023] [Accepted: 12/12/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Failure to rescue is the rate of death amongst patients with postoperative complications and has been proposed as a perioperative quality indicator. However, variation in its definition has limited comparisons between studies. We systematically reviewed all surgical literature reporting failure to rescue rates and examined variations in the definition of the 'numerator,' 'denominator,' and timing of failure to rescue measurement. METHODS Databases were searched from inception to 31 December 2022. All studies reporting postoperative failure to rescue rates as a primary or secondary outcome were included. We examined the complications included in the failure to rescue denominator, the percentage of deaths captured by the failure to rescue numerator, and the timing of measurement for complications and mortality. RESULTS A total of 359 studies, including 212,048,069 patients, were analyzed. The complications included in the failure to rescue denominator were reported in 295 studies (82%), with 131 different complications used. The median number of included complications per study was 10 (interquartile range 8-15). Studies that included a higher number of complications in the failure-to-rescue denominator reported lower failure-to-rescue rates. Death was included as a complication in the failure to rescue the denominator in 65 studies (18%). The median percentage of deaths captured by the failure to rescue calculation when deaths were not included in the denominator was 79%. Complications (52%) and mortality (40%) were mostly measured in-hospital, followed by 30-days after surgery. CONCLUSION Failure to rescue is an important concept in the study of postoperative outcomes, although its definition is highly variable and poorly reported. Researchers should be aware of the advantages and disadvantages of different approaches to defining failure to rescue.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand.
| | - Sameer Bhat
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora MidCentral, Palmerston North, New Zealand
| | - William Xu
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Tai Tokerau, Whangārei, New Zealand
| | - Chris Varghese
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of General Surgery, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Celia Keane
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Tai Tokerau, Whangārei, New Zealand
| | - Wal Baraza
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
| | - Chris Harmston
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Tai Tokerau, Whangārei, New Zealand
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Te Toka Tumai, Auckland, New Zealand
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Rangrass G, Obiyo L, Bradley AS, Brooks A, Estime SR. Closing the gap: Perioperative health care disparities and patient safety interventions. Int Anesthesiol Clin 2024; 62:41-47. [PMID: 38385481 DOI: 10.1097/aia.0000000000000439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Affiliation(s)
- Govind Rangrass
- Department of Anesthesiology and Critical Care, Saint Louis University Hospital/SSM Health, Saint Louis, Missouri
| | - Leziga Obiyo
- Department of Anesthesia & Critical Care, University of Chicago Medicine, Chicago, Illinois
| | - Anthony S Bradley
- Department of Anesthesiology, University of South Florida Moffitt Cancer Center, Tampa, Florida
| | - Amber Brooks
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Stephen R Estime
- Department of Anesthesia & Critical Care, University of Chicago Medicine, Chicago, Illinois
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Cawich SO, Dixon E, Shukla PJ, Shrikhande SV, Deshpande RR, Mohammed F, Pearce NW, Francis W, Johnson S, Bujhawan J. Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center: Value of tailored peri-pancreatectomy protocols. World J Gastrointest Surg 2024; 16:681-688. [PMID: 38577074 PMCID: PMC10989354 DOI: 10.4240/wjgs.v16.i3.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/03/2024] [Accepted: 01/27/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) is a technically complex operation, with a relatively high risk for complications. The ability to rescue patients from post-PD complications is as a recognized quality measure. Tailored protocols were instituted at our low volume facility in the year 2013. AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality. METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1, 2013 and June 30, 2023. Standardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications, and the modified Clavien-Dindo classification was used to classify post-PD complications. RESULTS Over the study period, 113 patients at a mean age of 57.5 years (standard deviation [SD] ± 9.23; range: 30-90; median: 56) underwent PDs at this facility. Major complications were recorded in 33 (29.2%) patients at a mean age of 53.8 years (SD: ± 7.9). Twenty-nine (87.9%) patients who experienced major morbidity were salvaged after aggressive treatment of their complication. Four (3.5%) died from bleeding pseudoaneurysm (1), septic shock secondary to a bile leak (1), anastomotic leak (1), and myocardial infarction (1). There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores ≤ 2 (93.3% vs 25%; P = 0.0024). CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD. Despite low volumes at our facility, we demonstrated that 87.9% of patients were rescued from major complications. We attributed this to several factors including development of rescue protocols, the competence of the pancreatic surgery teams and continuous, and adaptive learning by the entire institution, culminating in the development of tailored peri-pancreatectomy protocols.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Elijah Dixon
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N2T9, Canada
| | - Parul J Shukla
- Department of Surgery, Weill Cornell Medical College, New York, NY 10065, United States
| | - Shailesh V Shrikhande
- Department of Surgical Oncology, Tata Memorial Center, Homi Bhabha National University, Mumbai 400012, India
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Fawwaz Mohammed
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| | - Neil W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Wesley Francis
- Department of Surgery, University of the West Indies, Nassau N-1184, Bahamas
| | - Shaneeta Johnson
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, United States
| | - Johann Bujhawan
- Department of Surgery, General Hospital in Port of Spain, Port of Spain 000000, Trinidad and Tobago
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Feinstein M, Katz D, Demaria S, Hofer IS. Remote Monitoring and Artificial Intelligence: Outlook for 2050. Anesth Analg 2024; 138:350-357. [PMID: 38215713 PMCID: PMC10794024 DOI: 10.1213/ane.0000000000006712] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
Remote monitoring and artificial intelligence will become common and intertwined in anesthesiology by 2050. In the intraoperative period, technology will lead to the development of integrated monitoring systems that will integrate multiple data streams and allow anesthesiologists to track patients more effectively. This will free up anesthesiologists to focus on more complex tasks, such as managing risk and making value-based decisions. This will also enable the continued integration of remote monitoring and control towers having profound effects on coverage and practice models. In the PACU and ICU, the technology will lead to the development of early warning systems that can identify patients who are at risk of complications, enabling early interventions and more proactive care. The integration of augmented reality will allow for better integration of diverse types of data and better decision-making. Postoperatively, the proliferation of wearable devices that can monitor patient vital signs and track their progress will allow patients to be discharged from the hospital sooner and receive care at home. This will require increased use of telemedicine, which will allow patients to consult with doctors remotely. All of these advances will require changes to legal and regulatory frameworks that will enable new workflows that are different from those familiar to today's providers.
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Affiliation(s)
- Max Feinstein
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Daniel Katz
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Samuel Demaria
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
| | - Ira S. Hofer
- Department of Anesthesiology Pain and Perioperative Medicine, Icahn School of Medicine at Mount Sinai
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Lee MW, Vallejo A, Mandelbaum RS, Yessaian AA, Pham HQ, Muderspach LI, Roman LD, Klar M, Wright JD, Matsuo K. Temporal trends of failure-to-rescue following perioperative complications in vulvar cancer surgery in the United States. Gynecol Oncol 2023; 177:1-8. [PMID: 37597497 DOI: 10.1016/j.ygyno.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/09/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Failure-to-rescue, defined as mortality following a perioperative complication, is a perioperative quality indicator studied in various surgeries, but not in vulvar cancer surgery. The objective of this study was to assess failure-to-rescue in patients undergoing surgical therapy for vulvar cancer. METHODS This cross-section study queried the National Inpatient Sample. The study population was 31,077 patients who had surgical therapy for vulvar cancer from 1/2001-9/2015. The main outcomes were (i) perioperative morbidity (29 indicators) and (ii) mortality following a perioperative complication during the index admission for vulvar surgery (failure-to-rescue), assessed with a multivariable binary logistic regression model. RESULTS The cohort-level median age was 69 years, and 14,337 (46.1%) had medical comorbidity. Perioperative complications were reported in 4736 (15.2%) patients during the hospital admission for vulvar surgery. In multivariable analysis, patient factors including older age, medical comorbidity, and morbid obesity, and treatment factors with prior radiotherapy and radical vulvectomy were associated with perioperative complications (P < 0.05). The number of patients with morbid obesity, higher comorbidity index, and prior radiotherapy increased over time (P-trends < 0.001). Among 4736 patients who developed perioperative complications, 55 patients died during the hospital admission for vulvar surgery (failure-to-rescue rate, 1.2%). In multivariable analysis, cardiac arrest (adjusted-odds ratio [aOR] 27.25), sepsis or systemic inflammatory response syndrome (aOR 11.54), pneumonia (aOR 6.03), shock (aOR 4.37), and respiratory failure (aOR 3.10) were associated with failure-to-rescue (high-risk morbidities). There was an increasing trend of high-risk morbidities from 2.0% to 3.7% over time, but the failure-to-rescue from high-risk morbidities decreased from 9.1% to 2.8% (P-trend < 0.05). CONCLUSION Vulvar cancer patients undergoing surgical treatment had increased comorbidity over time with an increase in high-risk complications. However, failure-to-rescue rate has decreased significantly.
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Affiliation(s)
- Matthew W Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Andrew Vallejo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Rachel S Mandelbaum
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Annie A Yessaian
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Huyen Q Pham
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Laila I Muderspach
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg Faculty of Medicine, Freiburg, Germany
| | - Jason D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Shen Y, Zhang L, Wu P, Huang Y, Xin S, Zhang Q, Zhao S, Sun H, Lei G, Zhang T, Han W, Wang Z, Jiang J, Yu X. Construction and evaluation of networks among multiple postoperative complications. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 232:107439. [PMID: 36870170 DOI: 10.1016/j.cmpb.2023.107439] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVE Postoperative complications confer an increased risk of reoperation, prolonged length of hospital stay, and increased mortality. Many studies have attempted to identify the complex associations among complications to preemptively interrupt their progression, but few studies have looked at complications as a whole to reveal and quantify their possible trajectories of progression. The main objective of this study was to construct and quantify the association network among multiple postoperative complications from a comprehensive perspective to elucidate the possible evolution trajectories. METHODS In this study, a Bayesian network model was proposed to analyze the associations among 15 complications. Prior evidence and score-based hill-climbing algorithms were used to build the structure. The severity of complications was graded according to their connection to death, with the association between them quantified using conditional probabilities. The data of surgical inpatients used in this study were collected from four regionally representative academic/teaching hospitals in a prospective cohort study in China. RESULTS In the network obtained, 15 nodes represented complications or death, and 35 arcs with arrows represented the directly dependent relationship between them. With three grades classified on that basis, the correlation coefficients of complications within grades increased with increased grade, ranging from -0.11 to -0.06, 0.16, and 0.21 to 0.4 in grade 1 to grade 3, respectively. Moreover, the probability of each complication in the network increased with the occurrence of any other complication, even mild complications. Most seriously, once cardiac arrest requiring cardiopulmonary resuscitation occurs, the probability of death will be up to 88.1%. CONCLUSIONS The present evolving network can facilitate the identification of strong associations among specific complications and provides a basis for the development of targeted measures to prevent further deterioration in high-risk patients.
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Affiliation(s)
- Yubing Shen
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences / School of Basic Medicine, Peking Union Medical College, No.5, Dongdansantiao Street, Dong Cheng District, Beijing 100005, China
| | - Luwen Zhang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences / School of Basic Medicine, Peking Union Medical College, No.5, Dongdansantiao Street, Dong Cheng District, Beijing 100005, China
| | - Peng Wu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences / School of Basic Medicine, Peking Union Medical College, No.5, Dongdansantiao Street, Dong Cheng District, Beijing 100005, China
| | - Yuguang Huang
- Department of Anaesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shijie Xin
- Department of Vascular and Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China
| | - Qiang Zhang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Shengxiu Zhao
- Department of Nursing, Qinghai Provincial People's Hospital, Xining, Qinghai Province, China
| | - Hong Sun
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Taiping Zhang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Han
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences / School of Basic Medicine, Peking Union Medical College, No.5, Dongdansantiao Street, Dong Cheng District, Beijing 100005, China
| | - Zixing Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences / School of Basic Medicine, Peking Union Medical College, No.5, Dongdansantiao Street, Dong Cheng District, Beijing 100005, China
| | - Jingmei Jiang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences / School of Basic Medicine, Peking Union Medical College, No.5, Dongdansantiao Street, Dong Cheng District, Beijing 100005, China.
| | - Xiaochu Yu
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, No.1, ShuaiFuYuan, WangFuJing, Dong Cheng District, Beijing 100730, China.
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Wacker J. Quality indicators for anesthesia and perioperative medicine. Curr Opin Anaesthesiol 2023; 36:208-215. [PMID: 36689392 PMCID: PMC9973445 DOI: 10.1097/aco.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW Routine monitoring of care quality is fundamental considering the high reported rates of preventable perioperative morbidity and mortality. However, no set of valid and feasible quality indicators is available as the gold standard for comprehensive routine monitoring of the overall quality of perioperative care. The purpose of this review is to describe underlying difficulties, to summarize current trends and initiatives and to outline the perspectives in support of suitable perioperative quality indicators. RECENT FINDINGS Most perioperative quality indicators used in the clinical setting are based on low or no evidence. Evidence-based perioperative quality indicators validated for research purposes are not always applicable in routine care. Developing a core set of perioperative quality indicators for clinical practice may benefit from matching feasible routine indicators with evidence-based indicators validated for research, from evaluating additional new indicators, and from including patients' views. SUMMARY A core set of valid and feasible quality indicators is essential for monitoring perioperative care quality. The development of such a set may benefit from matching evidence-based indicators with feasible standard indicators and from including patients' views.
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Affiliation(s)
- Johannes Wacker
- Institute of Anaesthesia and Intensive Care, Hirslanden Clinic
- University of Zurich, Faculty of Medicine, Zurich, Switzerland
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