None listed
Conditions
Brief summary
The purpose of this study is to identify whether intra-operative advanced haemodynamic monitoring (AHDM) as compared to usual care monitoring for patient's undergoing major hepatobiliary-pancreatic (HPB) surgery results in increased rates of textbook outcomes (optimal post-surgical outcomes). Who is it for? The study will include adult patients undergoing major HPB surgery. This is a retrospective study to test the hypothesis that AHDM monitoring when compared to usual care monitoring will increase the rates of textbook outcomes for these patients. People aged 18 years or older who have undergone a liver or pancreatic surgery for one of a number of reasons, including removal of cancerous tissue, between January 2011 and December 2022 at the Austin Hospital, Knox Private or Warringal Private Hospitals may be included in this study. Please be advised that this study will not involve any active participation, only a review of previously recorded medical information from hospital records. Study details The aim of this study is to evaluate the rate of textbook outcomes for patients undergoing major HPB surgery who are monitored with AHDM (AHDM group) as compared to routine monitoring (usual care group). A textbook outcome represents the optimal course following a surgical episode, which is achieved when predefined parameters are fulfilled according to an all-or-none principle. Textbook outcomes will include absence of post operative leak, absence of liver failure, absence of pancreatic fistula, absence of pancreatic haemorrhage, no major post operative complications, no readmission within 90 days due to surgical complications, no in hospital or 90-day mortality and hospital length of stay less than the median length of stay. It is hoped that this study will be hypothesis generating and provide valuable data for power calculations for future studies on evaluating the use of AHDM for textbook outcomes for patients undergoing major HPB surgery.
Interventions
This is a retrospective analysis of post operative textbook outcomes in patients who underwent major hepatobiliary-pancreatic (HPB) surgery between January 2011 and December 2022 and were monitored intraoperatively with routine care monitoring i.e., the Usual care group) or advanced haemodynamic monitoring (AHDM), i.e., the AHDM group during this time period.
Usual care haemodynamic monitoring includes an invasive arterial line to measure continuous blood pressure and a central venous catheter
This is a retrospective analysis of post operative textbook outcomes in patients who underwent major hepatobiliary-pancreatic (HPB) surgery between January 2011 and December 2022 and were monitored intraoperatively with routine care monitoring i.e., the Usual care group) or advanced haemodynamic monitoring (AHDM), i.e., the AHDM group during this time period. Usual care haemodynamic monitoring includes an invasive arterial line to measure continuous blood pressure and a central venous catheter to measure central venous pressure. AHDM includes an invasive arterial line and central venous catheter (as above), in addition to measuring cardiac output, stroke volume, systemic vascular resistance, and stroke volume variation. Patients who underwent major HPB surgery at three university teaching hospitals between January 2011 and December 2022 will be included. Austin Hospital is a university hospital in Melbourne, Australia with a dedicated high volume hepato-pancreatic-biliary and liver transplant centre. Knox Private and Warringal Private Hospitals are teaching hospitals with expertise in major hepato-pancreatic-biliary surgery. All data will be collected from patient electronic medical records, with no additional involvement by the participant required. The following data points will be collected for each patient: • Patient demographics (e.g., age, sex, weight, height) • Blood workup results • Year of surgery, surgical procedure (laparoscopic, open or hybrid) and hospital performing the surgery • Total duration of surgery (minutes) • Use of AHDM or usual care • Vital signs • Urine output • Bleeding requiring blood and/or blood products • Intra-operative inotropic support and fluid use (including crystalloids and colloids) • Post-operative complications • ICU admission • Hospital length of stay • In-hospital or 90-day mortality • Readmission within 90-days after hospital discharge, due to surgery related complications As this is a retrospective study, data will be collected from medical records and there will be no patient involvement.
Sponsors
Austin Health - Austin Hospital, Heidelberg
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion criteria for this study include: 1. Equal to or greater than 18 years of age 2. Elective major HPB surgery via laparoscopic, open or a hybrid approach (between Jan 2011 and Dec 2022) 3. HPB surgery is not in conjunction with any other abdominal surgery (e.g., bowel resection)
Exclusion criteria
Exclusion criteria for this study include: 1. Emergency major HPB surgery 2. HPB surgery in conjunction with any other abdominal surgery (e.g., bowel resection) 3. Patients undergoing liver transplantation
Outcome results
None listed