Rapid response team activation after major hip surgery: A case series. (January 2022)

• Record Type: Journal Article
• Authors: Weinberg, Laurence; Pritchard, Angus; Louis, Maleck; Jones, Daryl; Hardidge, Andrew; Churilov, Leonid
• Is Part Of: International journal of surgery case reports. Volume 90(2022)
• Publication Date: 2022-01
• Subjects: Rapid response team -- Medical emergency team -- Orthopedics -- Hip arthroplasty -- Anesthesia -- Perioperative; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106699
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction: We describe the demographic, preoperative, surgical, anesthetic, and postoperative characteristics of patients who required a rapid response team (RRT) activation after major hip surgery. We determined the characteristics and outcomes of patients that require RRTs after major hip surgery, and their associations with mortality. Presentation of cases: We retrospectively reviewed adult patients undergoing major hip surgery in a university teaching hospital. We included patients who had an RRT or "code blue" activation post-surgery and within the index hospital admission. We extracted patient, surgical, anesthetic, and postoperative variables. We explored differences between patients who survived their index hospital stay and those who died. Discussion: 187 (9%) patients had a postoperative RRT activation. The median age was 84.0 (78–90) years; 125 (67%) were female, and most patients had significant comorbidities. The median Charlson Comorbidity Index (CCI) was 5.0 (4.0–7.0). Patients were frail (68%), ASA physical status ≥Class 3 (91%) and underwent emergency surgery (88%). Death after RRT activation occurred in 1 in 7 patients. Compared to patients who survived RRT activation, those who died had a higher mean CCI (6.5 [1.8] vs. 5.5 [2.1], P = 0.02), were more frail (80.1% vs. 56.5%, OR = 3.2, 95% CI: 1.2, 8.1; P = 0.03), and received less intraoperative opioids (intravenous morphine equi-analgesia: median = 5.8 (0.1–8.20 vs. 11.7 (3.7–19.0) mg, P = 0.03). Conclusion: Mortality after RRT activation is associated with non-modifiable patients factors rather than surgical or anesthesia factors. Our findings provide opportunities for the implementation of strategies aimed at improving postoperative outcomes. Highlights: Major hip surgery poses a significant physiological challenge to patients. Almost one in ten patients had a postoperative rapid response team activation. Mortality rate was one in seven patients following rapid response team activation. Advanced age, frailty and emergency surgery were associated with RRT activation. Death post RRT activation was not associated with surgical or anesthesia factors.