Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes.

Autor: Melamed R; Department of Critical Care Medicine, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407 USA., Boland LL; Division of Applied Research, Allina Health, 2925 Chicago Ave South, Minneapolis, MN USA., Normington JP; Division of Applied Research, Allina Health, 2925 Chicago Ave South, Minneapolis, MN USA., Prenevost RM; Division of Applied Research, Allina Health, 2925 Chicago Ave South, Minneapolis, MN USA., Hur LY; Department of Pharmacy, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN USA., Maynard LF; Chronic Pain Team, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN USA., McNaughton MA; Chronic Pain Team, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN USA., Kinzy TG; Division of Applied Research, Allina Health, 2925 Chicago Ave South, Minneapolis, MN USA., Masood A; Department of Critical Care Medicine, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN 55407 USA., Dastrange M; Internal Medicine Residency Program, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN USA., Huguelet JA; Internal Medicine Residency Program, Abbott Northwestern Hospital, 800 East 28th Street, Minneapolis, MN USA.
Jazyk: angličtina
Zdroj: Perioperative medicine (London, England) [Perioper Med (Lond)] 2016 Aug 02; Vol. 5, pp. 19. Date of Electronic Publication: 2016 Aug 02 (Print Publication: 2016).
DOI: 10.1186/s13741-016-0044-1
Abstrakt: Background: Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and management modifications is an important part of postoperative care. Patients with unanticipated respiratory decompensation requiring transfer to the intensive care unit (ICU) have not been studied in sufficient detail.
Methods: A retrospective case-control study of elective orthopedic surgery patients (knee, hip, shoulder, or spine, n = 51) who developed unanticipated respiratory failure (RF) necessitating transfer to the ICU over a 3-year period was conducted. Controls (n = 153) were frequency matched to cases by gender, age, and surgical procedure. Patient and perioperative care factors, clinical outcomes, and cost of care were examined.
Results: Transfer to the ICU occurred within 48 h of surgery in 73 % of the cases, 31 % required non-invasive ventilation, and 18 % required mechanical ventilation. Cases had a higher prevalence of chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and regular psychotropic medication use than controls. Cases received more intravenous opioids during the first 24 postoperative hours, were hospitalized 4 days longer, had higher in-hospital mortality, and had excess hospitalization costs of US$26,571. COPD, OSA, preoperative psychotropic medications, and anesthesia time were associated with risk of RF in a multivariate analysis.
Conclusions: Unanticipated RF after orthopedic surgery is associated with extended hospitalization, increased mortality, and higher cost of care. Hospital protocols that include risk factor assessment, enhanced monitoring, and a cautious approach to opioid use in high-risk patients may reduce the frequency of this complication.
Databáze: MEDLINE
Externí odkaz: