Anesthesia Quality Improvement and Patients With Planned ICU Admission

Overview

Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. The concept of Enhanced Recovery After Surgery recommends early extubation. We suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing complications.

Full Title of Study: “Effects of Anesthesia Quality Improvement on Outcomes of Patients With Planned ICU Admission: a Prospective Pre-post Intervention Study”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Non-Randomized
    • Intervention Model: Sequential Assignment
    • Primary Purpose: Prevention
    • Masking: None (Open Label)
  • Study Primary Completion Date: May 2024

Detailed Description

Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. Studies found that immediate ICU admission after surgery did not reduce the perioperative mortality. Some authors suggested that the indication of ICU admission should be the occurrence of postoperative complications, which will reasonably reduce the use of medical resources. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. Old age, high ASA grade, respiratory complications, long duration surgery, large-volume fluid infusion, and use of vasopressors were main factors associated with delayed recovery. The concept of Enhanced Recovery After Surgery recommends early extubation after surgery. Studies showed that, for patients after organ transplantation, immediate extubation in the operating room can shorten hospital stay and reduce medical costs, without increasing mortality. We suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing postoperative complications.

Interventions

  • Procedure: Routine care
    • • Implementing anesthesia management according to current routine practice.
  • Procedure: Anesthesia improvement
    • Encourage regional anesthesia or combined regional-general anesthesia. Encourage goal-directed fluid therapy, lung-protective ventilation, and active warming during surgery. Encourage extubation in the operating room at the end of surgery. Encourage multimodal analgesia after surgery. Encourage strict indication for ICU admission after surgery.

Arms, Groups and Cohorts

  • Active Comparator: Routine care
    • • Implementing anesthesia management according to current routine practice.
  • Experimental: Anesthesia improvement
    • Encourage regional anesthesia or combined regional-general anesthesia. Encourage goal-directed fluid therapy, lung-protective ventilation, and active warming during surgery. Encourage extubation in the operating room at the end of surgery. Encourage multimodal analgesia after surgery. Encourage strict indication for ICU admission after surgery.

Clinical Trial Outcome Measures

Primary Measures

  • Incidence of postoperative complication
    • Time Frame: Up to 30 days after surgery
    • Postoperative complications are defined as newly occurred medical conditions that are considered harmful to patients’ recovery and require therapeutic intervention, that is grade II or higher on Clavin-Dindo classification.

Secondary Measures

  • Rate of ICU admission
    • Time Frame: On the 1 day of surgery
    • Rate of ICU admission
  • Incidence of postoperative delirium
    • Time Frame: Up to 5 days after surgery
    • Delirium is assessed with the Three-dimensional Confusion Assessment Method (3D-CAM) twice daily (8:00-10:00 am and 18:00-20:00 pm).
  • Rate of delayed neurocognitive recovery
    • Time Frame: up to 7 days after surgery
    • Cognitive function is assessed with the Montreal Cognitive Assessment (MoCA) before surgery and at discharge. A decrease of 2 points or more is defined as the development of delayed neurocognitive recovery.
  • Length of stay in hospital after surgery
    • Time Frame: Up to 30 days after surgery
    • Length of stay in hospital after surgery
  • Medical costs during hospitalization
    • Time Frame: Up to 30 days after surgery
    • Medical costs during hospitalization

Participating in This Clinical Trial

Inclusion Criteria

  • Age ≥18 years. – Scheduled to undergo elective surgery. – Planned ICU admission after surgery. Exclusion Criteria:

  • Refused to participate in the study. – ICU admission before surgery. – Unexpected ICU admission. – Other conditions that are considered unsuitable for study participation.

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Peking University First Hospital
  • Provider of Information About this Clinical Study
    • Principal Investigator: Dong-Xin Wang, Professor and Chairman, Department of Anesthesiology and Critical Care Medicine – Peking University First Hospital
  • Overall Official(s)
    • Dong-Xin Wang, MD, PhD, Principal Investigator, Peking University First Hospital
  • Overall Contact(s)
    • Dong-Xin Wang, MD, PhD, 8610-83572784, wangdongxin@hotmail.com

References

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