Rapid response team activation after major hip surgery: A case series

Area of Science:

• Anesthesiology
• Geriatric Medicine
• Surgical Outcomes

Background:

• Major hip surgery patients requiring Rapid Response Team (RRT) activation often present with significant comorbidities and frailty.
• Postoperative RRT activation impacts a notable percentage of patients undergoing major hip surgery.

Purpose of the Study:

• To characterize patients who experience RRT activation after major hip surgery.
• To determine the association between patient factors, surgical/anesthetic variables, and mortality following RRT activation.

Main Methods:

• Retrospective review of adult patients undergoing major hip surgery with RRT or "code blue" activation during their hospital stay.
• Extraction and analysis of patient demographics, comorbidities (Charlson Comorbidity Index), frailty status, surgical, anesthetic, and postoperative variables.
• Comparison of characteristics between patients who survived and those who died after RRT activation.

Main Results:

• 187 (9%) patients had postoperative RRT activation, with a median age of 84 years and high rates of comorbidities (CCI 5.0) and frailty (68%).
• Patients who died after RRT activation had higher Charlson Comorbidity Index scores, greater frailty, and received less intraoperative opioids compared to survivors.
• Mortality occurred in 1 in 7 patients following RRT activation.

Conclusions:

• Mortality post-RRT activation is primarily associated with non-modifiable patient factors like frailty and comorbidities.
• Findings suggest opportunities for targeted interventions to improve postoperative outcomes in high-risk hip surgery patients.
• Surgical and anesthetic factors appear less influential on mortality risk after RRT activation.