Trends in perioperative practices of high-risk surgical patients over a 10-year interval

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter coho...

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Published in:PloS one Vol. 18; no. 9; p. e0286385
Main Authors: Gomes, Brenno Cardoso, Lobo, Suzana Margareth Ajeje, Sá Malbouisson, Luiz Marcelo, de Freitas Chaves, Renato Carneiro, Domingos Corrêa, Thiago, Prata Amendola, Cristina, Silva Júnior, João Manoel
Format: Journal Article
Language:English
Published: San Francisco Public Library of Science 19-09-2023
Public Library of Science (PLoS)
Subjects:
Biology and Life Sciences
Blood pressure
Blood transfusion
Brazil
Cardiovascular disease
Complications
Correspondence
Creatinine
Death
Diabetes
Evaluation
Health aspects
Hospital patients
Hospitals
Hypertension
Infections
Intensive care
Length of stay
Matching
Medical research
Medicine and Health Sciences
Medicine, Experimental
Mortality
Patients
People and places
Perioperative care
Postoperative period
Regression analysis
Research ethics
Risk
Statistics
Surgery
Trends
United Kingdom
Variables
Ventilators
Brazil
United Kingdom
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Summary:In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart. The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards. After matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1-29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0-2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36-4.20) and hospital stay (HR = 1.64, 95% CI: 1.03-2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01-1.06), higher creatinine (OR = 1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery. In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.
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Competing Interests: The authors have declared that no competing interests exist.
Membership of the BraSIS research group is provided in the Acknowledgments
These authors also contributed equally to this work
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0286385