The characteristics, types of intervention, and outcomes of postoperative patients who required rapid response system intervention: A nationwide database analysis

概要

PURPOSE:
　Improving the safety of general wards is a key to reducing serious adverse events in the postoperative period. We investigated the characteristics, treatment, and outcomes of postoperative patients managed by a rapid response system (RRS) in Japan to improve postoperative management.

METHODS:
　This retrospective study analyzed cases requiring RRS intervention that were included in the In-Hospital Emergency Registry in Japan (IHER-J). We analyzed data reported by 34 Japanese hospitals between January 2014 and March 2018, mainly focusing on postoperative patients for whom the RRS was activated within 7 days of surgery. Non- postoperative patients, for whom the RRS was activated in all other settings, were used for comparison as necessary.

RESULTS:
　There were 609 (12.7%) postoperative patients among the total patients in the IHER-J registry. The major criteria were staff concerns (30.2%) and low oxygen saturation (29.7%). Hypotension, tachycardia, and inability to contact physicians were observed as triggers significantly more frequently in postoperative patients when compared with non- postoperative patients. Among RRS activations within 7 days of surgery, 68.9% of activations occurred within postoperative day 3. The ordering of tests (46.8%) and fluid bolus (34.6%) were major interventions that were performed significantly more frequently in postoperative patients when compared with non-postoperative patients. The rate of RRS activations resulting in ICU care was 32.8%. The mortality rate at 1 month was 16.2%.

CONCLUSION:
　Approximately 70% of the RRS activations occurred within postoperative day 3. Circulatory problems were a more frequent cause of RRS activation in the postoperative group than in the non-postoperative group.