Effects of Anesthesia Quality Improvement on Outcomes of Patients With Planned ICU Admission: a Prospective Pre-post Intervention Study
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Anesthesia
- Sponsor
- Peking University First Hospital
- Enrollment
- 1500
- Locations
- 1
- Primary Endpoint
- Incidence of postoperative complication
- Status
- Completed
- Last Updated
- last year
Overview
Brief Summary
Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. The concept of Enhanced Recovery After Surgery recommends early extubation. The investigators suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing complications.
Detailed Description
Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. Studies found that immediate ICU admission after surgery did not reduce the perioperative mortality. Some authors suggested that the indication of ICU admission should be the occurrence of postoperative complications, which will reasonably reduce the use of medical resources. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. Old age, high ASA grade, respiratory complications, long duration surgery, large-volume fluid infusion, and use of vasopressors were main factors associated with delayed recovery. The concept of Enhanced Recovery After Surgery recommends early extubation after surgery. Studies showed that, for patients after organ transplantation, immediate extubation in the operating room can shorten hospital stay and reduce medical costs, without increasing mortality. The investigators suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing postoperative complications.
Investigators
Dong-Xin Wang
Professor and Chairman, Department of Anesthesiology and Critical Care Medicine
Peking University First Hospital
Eligibility Criteria
Inclusion Criteria
- •Age ≥18 years.
- •Scheduled to undergo elective surgery.
- •Planned ICU admission after surgery.
Exclusion Criteria
- •Refused to participate in the study.
- •ICU admission before surgery.
- •Unexpected ICU admission.
- •Other conditions that are considered unsuitable for study participation.
Outcomes
Primary Outcomes
Incidence of postoperative complication
Time Frame: Up to 30 days after surgery
Postoperative complications are defined as newly occurred medical conditions that are considered harmful to patients' recovery and require therapeutic intervention, that is grade II or higher on Clavin-Dindo classification.
Secondary Outcomes
- Rate of ICU admission(On the 1 day of surgery)
- Incidence of postoperative delirium(Up to 5 days after surgery)
- Rate of delayed neurocognitive recovery(up to 7 days after surgery)
- Length of stay in hospital after surgery(Up to 30 days after surgery)
- Medical costs during hospitalization(Up to 30 days after surgery)