Developing models to predict early postoperative patient deterioration and adverse events.

Area of Science:

• Anesthesiology
• Perioperative Medicine
• Surgical Outcomes

Background:

• Accurate identification of patients at risk of early postoperative deterioration is crucial for appropriate care allocation.
• This study addresses the need for evidence-based perioperative planning and resource allocation to high-acuity facilities.

Purpose of the Study:

• To determine the incidence of early postoperative deterioration.
• To identify patient and surgical factors predictive of postoperative deterioration.

Main Methods:

• Prospective data collection from 747 elective non-cardiac surgical patients (May-August 2013).
• Analysis of preoperative patient and surgical factors, and postoperative events in the post-anesthesia care unit (PACU) and wards for 72 hours.
• Binomial logistic regression used to compare factors associated with ward deterioration.

Main Results:

• Postoperative deterioration occurred in 20.1% in PACU and 16.7% on wards.
• Common ward events included hypotension (8.2%) and desaturation (6.2%).
• Predictive factors for ward deterioration included atrial fibrillation, chronic liver disease, surgery duration, and excessive PACU sedation; surgical complexity was not predictive.

Conclusions:

• Patient factors, surgery duration, and PACU events predict early postoperative ward deterioration.
• This predictive information can guide perioperative decision-making for high-acuity facility utilization.