Risk factors and outcomes of postoperative emergency response team activation: a matched case-control study

To determine patient and perioperative characteristics associated with unexpected postoperative clinical deterioration as determined for the need of a postoperative emergency response team (ERT) activation.

Retrospective case-control study.

Tertiary academic hospital.

Patients who underwent general anaesthesia discharged to regular wards between 1 January 2013 and 31 December 2015 and required ERT activation within 48 postoperative hours. Controls were matched based on age, sex and procedure.

Baseline patient and perioperative characteristics were abstracted to develop a multiple logistic regression model to assess for potential associations for increased risk for postoperative ERT.

Among 105 345 patients, 797 had ERT calls, with a rate of 7.6 (95% CI, 7.1-8.1) calls per 1000 anaesthetics (0.76%). Multiple logistic regression analysis showed the following risk factors for postoperative ERT: cardiovascular disease (odds ratio [OR], 1.61; 95% CI, 1.18-2.18), neurological disease (OR, 1.57; 95% CI, 1.11-2.22), preoperative gabapentin (OR, 1.60; 95% CI, 1.17-2.20), longer surgical duration (OR, 1.06; 95% CI, 1.02-1.11, per 30 min), emergency procedure (OR, 1.54; 95% CI, 1.09-2.18), and intraoperative use of colloids (OR, 1.50; 95% CI, 1.17-1.92). Compared with control participants, ERT patients had a longer hospital stay, a higher rate of admissions to critical care (55.5%), increased postoperative complications, and a higher 30-day mortality rate (OR, 3.36; 95% CI, 1.73-6.54).

We identified several patient and procedural characteristics associated with increased likelihood of postoperative ERT activation. ERT intervention is a marker for increased rates of postoperative complications and death.