Anesthesia, Extubation, Intensive Care Unit, Postoperative Complications
Conditions
Keywords
Anesthesia management, Early extubation, Intensive care unit admission, Postoperative Complications
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.
Interventions
OTHERImproved anesthesia care
* Encourage regional anesthesia or combined regional-general anesthesia. * Encourage goal-directed fluid therapy, lung-protective ventilation, and active warming during surgery. * Encourage extubation in the operating room at the end of surgery. * Encourage multimodal analgesia after surgery. * Encourage strict indication for ICU admission after surgery.
OTHERRoutine anesthesia care
• Implementing anesthesia management according to current routine practice.
Sponsors
Peking University First Hospital
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of postoperative complication | 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
| Measure | Time frame | Description |
|---|---|---|
| Incidence of postoperative delirium | Up to 5 days after surgery | Delirium is assessed with the Three-dimensional Confusion Assessment Method (3D-CAM) twice daily (8:00-10:00 am and 18:00-20:00 pm). |
| Rate of ICU admission | On the 1 day of surgery | Rate of ICU admission |
| Rate of delayed neurocognitive recovery | up to 7 days after surgery | Cognitive function is assessed with the Montreal Cognitive Assessment (MoCA) before surgery and at discharge. A decrease of 1 standard deviation (SD) or more from baseline is defined as the development of delayed neurocognitive recovery. |
| Length of stay in hospital after surgery | Up to 30 days after surgery | Length of stay in hospital after surgery |
| Medical costs during hospitalization | Up to 30 days after surgery | Medical costs during hospitalization |
Other
| Measure | Time frame | Description |
|---|---|---|
| Rate of ICU re-admission | Up to 30 days after surgery | ICU re-admission is defined as ICU admission from the general wards after surgery |
| All-cause 30-day mortality | Up to 30 days after surgery | All-cause 30-day mortality |
| Length of stay in ICU after surgery | Up to 30 days after surgery | Length of stay in ICU after surgery |
| Duration of mechanical ventilation | up to 30 days after surgery | Duration of mechanical ventilation |
Countries
China
Outcome results
None listed