Top

Published in:

Open Access 01-12-2018 | Research

Anesthesia interventions that alter perioperative mortality: a scoping review

Authors: Sylvain Boet, Cole Etherington, David Nicola, Andrew Beck, Susan Bragg, Ian D. Carrigan, Sarah Larrigan, Cassandra T. Mendonca, Isaac Miao, Tatyana Postonogova, Benjamin Walker, José De Wit, Karim Mohamed, Nadia Balaa, Manoj Mathew Lalu, Daniel I McIsaac, David Moher, Adrienne Stevens, Donald Miller, On behalf of the Perioperative Anesthesia Clinical Trials Group (PACT)

Published in: Systematic Reviews | Issue 1/2018

Abstract

Background

With over 230 million surgical procedures performed annually worldwide, better application of evidence in anesthesia and perioperative medicine may reduce widespread variation in clinical practice and improve patient care. However, a comprehensive summary of the complete available evidence has yet to be conducted. This scoping review aims to map the existing literature investigating perioperative anesthesia interventions and their potential impact on patient mortality, to inform future knowledge translation and ultimately improve perioperative clinical practice.

Methods

Searches were conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library databases from inception to March 2015. Study inclusion criteria were adult patients, surgical procedures requiring anesthesia, perioperative intervention conducted/organized by a professional with training in anesthesia, randomized controlled trials (RCTs), and patient mortality as an outcome. Studies were screened for inclusion, and data was extracted in duplicate by pairs of independent reviewers. Data were extracted, tabulated, and reported thematically.

Results

Among the 10,505 publications identified, 369 RCTs (n = 147,326 patients) met the eligibility criteria. While 15 intervention themes were identified, only 7 themes (39 studies) had a significant impact on mortality: pharmacotherapy (n = 23), nutritional (n = 3), transfusion (n = 4), ventilation (n = 5), glucose control (n = 1), medical device (n = 2), and dialysis (n = 1).

Conclusions

By mapping intervention themes, this scoping review has identified areas requiring further systematic investigation given their potential value for reducing patient mortality as well as areas where continued investment may not be cost-effective given limited evidence for improving survival. This is a key starting point for future knowledge translation to optimize anesthesia practice.

Available only for authorised users

Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008;372(9633):139–44. https://doi.org/10.1016/S0140-6736(08)60878-8S0140-6736(08)60878-8 [pii].CrossRefPubMed

Meakins JL, Giobbie-Hurder A, Jonasson O, et al. Evidence-based surgery. Surg Clin North Am. 2006;86(1):1–16, vii. https://doi.org/10.1016/j.suc.2005.10.004.CrossRefPubMed

Hackbarth AD, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513. https://doi.org/10.1001/jama.2012.362.CrossRefPubMed

Beaupre LA, Jones CA, Saunders LD, Johnston DWC, Buckingham J, Majumdar SR. Best practices for elderly hip fracture patients. J Gen Intern Med. 2005;20(11):1019–25. https://doi.org/10.1111/j.1525-1497.2005.00219.x.CrossRefPubMedPubMedCentral

Mazzocco K, Petitti DB, Fong KT, et al. Surgical team behaviors and patient outcomes. Am J Surg. 2009;197(5):678–85. https://doi.org/10.1016/j.amjsurg.2008.03.002.CrossRefPubMed

Pronovost PJ, Rinke ML, Emery K, Dennison C, Blackledge C, Berenholtz SM. Interventions to reduce mortality among patients treated in intensive care units. J Crit Care. 2004;19(3):158–64. https://doi.org/10.1016/j.jcrc.2004.07.003.CrossRefPubMed

Shehata N, Wilson K, Mazer CD, et al. The proportion of variation in perioperative transfusion decisions in Canada attributable to the hospital. Can J Anesth Can d’anesthésie. 2007;54(11):902–7. https://doi.org/10.1007/BF03026794.CrossRef

Kalhan R, Mikkelsen M, Dedhiya P, et al. Underuse of lung protective ventilation: analysis of potential factors to explain physician behavior*. Crit Care Med. 2006;34(2):300–6. https://doi.org/10.1097/01.CCM.0000198328.83571.4A.CrossRefPubMed

Weller JM, Merry AF. I. Best practice and patient safety in anaesthesia. Br J Anaesth. 2013;110(5):671–3. https://doi.org/10.1093/bja/aet011.CrossRefPubMed

10.

Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol. 1999;20(11):725–30. https://doi.org/10.1086/501572.CrossRefPubMed

11.

Boyce JM, Potter-Bynoe G, Dziobek L. Hospital reimbursement patterns among patients with surgical wound infections following open heart surgery. Infect Control Hosp Epidemiol. 1990;11(2):89–93. https://doi.org/10.2307/30144267.CrossRefPubMed

12.

Asensio Vegas A, Monge Jodra V, Lizán García M, Asensio Vegasi A, Lizan Garcia M. Nosocomial infection in surgery wards: a controlled study of increased duration of hospital stays and direct cost of hospitalization. Source Eur J Epidemiol Eur J Epidemiol Eur J Epidemiol. 1993;9(5):504–10 http://www.jstor.org/stable/3520947. Accessed 25 May 2017.

13.

Poulsen KB, Bremmelgaard A, Sorensen AI, Raahave D, Petersen JV. Estimated costs of postoperative wound infections: a case-control study of marginal hospital and social security costs. Epidemiol Infect. 1994;113:283–95 https://www-ncbi-nlm-nih-gov.proxy1.lib.uwo.ca/pmc/articles/PMC2271539/pdf/epidinfect00047-0085.pdf. Accessed 25 May 2017.CrossRefPubMedPubMedCentral

14.

Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996;334(19):1209–16. https://doi.org/10.1056/NEJM199605093341901.CrossRefPubMed

15.

Harper CM, Andrzejowski JC, Alexander R. NICE and warm. Br J Anaesth. 2008;101(3):293–5. https://doi.org/10.1093/bja/aen233.CrossRefPubMed

16.

Cheng D, Martin J. Evidence-based practice and health technology assessment: a call for anesthesiologists to engage in knowledge translation. Can J Anesth Can d’anesthésie. 2011;58(4):354–63. https://doi.org/10.1007/s12630-011-9463-0.CrossRef

17.

Graham ID, Logan J, Harrison MB, et al. Lost in knowledge translation: time for a map? J Contin Educ Heal Prof. 2006;26(1):13–24. https://doi.org/10.1002/chp.47.CrossRef

18.

Tricco AC, Cogo E, Ashoor H, et al. Sustainability of knowledge translation interventions in healthcare decision-making: protocol for a scoping review. BMJ Open. 2013;3(5):e002970. https://doi.org/10.1136/bmjopen-2013-002970.CrossRefPubMedPubMedCentral

19.

Straus S, Tetroe J, Graham I. Knowledge translation in health care: moving from evidence to practice. London: BMJ Books; 2013.

20.

Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493 http://www.bmj.com.proxy1.lib.uwo.ca/content/321/7275/1493.long. Accessed 25 May 2017.CrossRefPubMedPubMedCentral

21.

Landoni G, Rodseth RN, Santini F, et al. Randomized evidence for reduction of perioperative mortality. J Cardiothorac Vasc Anesth. 2012;26(5):764–72. https://doi.org/10.1053/j.jvca.2012.04.018.CrossRefPubMed

22.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32. https://doi.org/10.1080/1364557032000119616.CrossRef

23.

Armstrong R, Hall BJ, Doyle J, Waters E. “Scoping the scope” of a Cochrane review. J Public Health (Bangkok). 2011;33(1):147–50. https://doi.org/10.1093/pubmed/fdr015.CrossRef

24.

Rumrill PD, Fitzgerald SM, Merchant WR. Using scoping literature reviews as a means of understanding and interpreting existing literature. Work. 2010;35(3):399–404. https://doi.org/10.3233/WOR-2010-0998.CrossRefPubMed

25.

Brien SE, Lorenzetti DL, Lewis S, Kennedy J, Ghali WA. Overview of a formal scoping review on health system report cards. Implement Sci. 2010;5(1):2. https://doi.org/10.1186/1748-5908-5-2.CrossRefPubMedPubMedCentral

26.

Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73. https://doi.org/10.7326/M18-0850.CrossRefPubMed

27.

Levac D, Colquhoun H, O’Brien K. Scoping studies: advancing the methodology. Implement Sci. 2010;5(69):1–9. https://doi.org/10.1111/j.1468-0009.2005.00403.x.CrossRef

28.

Warters R, Szmuk P, Pivalizza E, Gebhard R, Ezri T. Preoperative antibiotic prophylaxis: the role of the anesthesiologist. Anesthesiology. 2003;99(2):515–6 http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1943451. Accessed 4 Aug 2017.CrossRef

29.

Healy DA, Clarke Moloney M, McHugh SM, Grace PA, Walsh SR. Remote ischaemic preconditioning as a method for perioperative cardioprotection: concepts, applications and future directions. Int J Surg. 2014;12(10):1093–9. https://doi.org/10.1016/j.ijsu.2014.08.352.CrossRefPubMed

30.

Auriant I, Jallot A, Hervé P, et al. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med. 2001;164(7):1231–5. https://doi.org/10.1164/ajrccm.164.7.2101089.CrossRefPubMed

31.

Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C. An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol. 2009;62(9):944–52. https://doi.org/10.1016/j.jclinepi.2008.10.012.CrossRefPubMed

32.

McGowan J, Sampson M, Lefebvre C. An Evidence Based Checklist for the Peer Review of Electronic Search Strategies (PRESS EBC). Evid Based Libr Inf Pract. 2010;5(1):149. https://doi.org/10.18438/B8SG8R.CrossRef

33.

Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D. Evidence summaries: the evolution of a rapid review approach. Syst Rev Rev. 2012;1:10. https://doi.org/10.7326/0003-4819-148-10-200805200-00010.CrossRef

34.

Moher D, Squires JE, Kolehmainen N, et al. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. Ann Intern Med. 2009;151(4):264. https://doi.org/10.7326/0003-4819-151-4-200908180-00135.CrossRefPubMed

35.

Cooper S, Hulley C, Grimley C, et al. Perioperative peripheral parenteral nutrition for patients undergoing esophagectomy for cancer: a pilot study of safety, surgical, and nutritional outcomes. Int J Surg. 2006;91:358–64.

36.

Wu G, Liu Z, Wu Z. Perioperative artificial nutrition in malnourished gastrointestinal cancer patients. World J Gastroenterol. 2006;12(15):2441–4.CrossRefPubMedPubMedCentral

37.

Duncan DG, Duncan DG, Beck SJ, Hood K, Johansen A. Using dietetic assistants to improve the outcome of hip fracture: a randomised controlled trial of nutritional support in an acute trauma ward. Age Ageing. 2005;35:148–53. https://doi.org/10.1093/ageing/afj011.CrossRefPubMed

38.

Bilgin YM. Double-blind, randomized controlled trial on the effect of leukocyte-depleted erythrocyte transfusions in cardiac valve surgery. Circulation. 2004;109(22):2755–60. https://doi.org/10.1161/01.CIR.0000130162.11925.21.CrossRefPubMed

39.

van de Watering LM, Hermans J, Houbiers JG, et al. Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial. Circulation. 1998;97(6):562–8 http://www.ncbi.nlm.nih.gov/pubmed/9494026. Accessed 4 Sept 2018.CrossRefPubMed

40.

Foss NB, Tange Kristensen M, Søe Jensen P, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion. 2009;49(2):227–34. https://doi.org/10.1111/j.1537-2995.2008.01967.x.CrossRefPubMed

41.

Kosmadakis N, Messaris E, Maris A, et al. Perioperative erythropoietin administration in patients with gastrointestinal tract cancer prospective randomized double-blind study. Annals of surgery. 2003;237(3):417 https://v2dis-prod.evidencepartners.com/Generic/getAttachment2.php?id=225. Accessed 25 Oct 2017.PubMedPubMedCentral

42.

Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med. 2000;28(10):3396–404. https://doi.org/10.1097/00003246-200010000-00003.CrossRefPubMed

43.

Meyhoff CS, Jorgensen LN, Wetterslev J, Christensen KB, Rasmussen LS. Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery: follow-up of a randomized clinical trial. Anesth Analg. 2012;115(4):849–54. https://doi.org/10.1213/ANE.0b013e3182652a51.CrossRefPubMed

44.

Antonelli M, Conti G, Bufi M, et al. Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation. JAMA. 2000;283(2):235. https://doi.org/10.1001/jama.283.2.235.CrossRefPubMed

45.

Zhu GF, Wang DJ, Lui S, et al. Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery. Chin Med J. 2013;126(2009):4463–9. https://doi.org/10.3760/cma.j.issn.0366-6999.20131704.CrossRefPubMed

46.

Thielmann M, Kottenberg E, Kleinbongard P, et al. Cardioprotective and prognostic effects of remote ischaemic preconditioning in patients undergoing coronary artery bypass surgery: a single-centre randomised, double-blind, controlled trial. Lancet. 2013;382(17):597–604. https://doi.org/10.1016/S0140-6736(13)61450-6.CrossRefPubMed

47.

Qiu Z, Chen X, Xu M, et al. Evaluation of preoperative intra-aortic balloon pump in coronary patients with severe left ventricular dysfunction undergoing OPCAB surgery: early and mid-term outcomes. J Cardiothorac Surg. 2009;4(1):39. https://doi.org/10.1186/1749-8090-4-39.CrossRefPubMedPubMedCentral

48.

Durmaz I, Yagdi T, Calkavur T, et al. Prophylactic dialysis in patients with renal dysfunction undergoing on-pump coronary artery bypass surgery. Ann Thorac Surg. 2003;75(02):859–64. https://doi.org/10.1016/S0003-4975(02)04635-0.CrossRefPubMed

49.

Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19) https://v2dis-prod.evidencepartners.com/Generic/getAttachment2.php?id=1414. Accessed 25 Oct 2017.

50.

Landoni G, Pisano A, Lomivorotov V, et al. Randomized evidence for reduction of perioperative mortality: an updated consensus process. J Cardiothorac Vasc Anesth. 2017;31(2):719–30. https://doi.org/10.1053/j.jvca.2016.07.017.CrossRefPubMed

51.

McIsaac DI, Wijeysundera DN, Huang A, Bryson GL, van Walraven C. Association of hospital-level neuraxial anesthesia use for hip fracture surgery with outcomes. Anesthesiology. 2018;128(3):480–91. https://doi.org/10.1097/ALN.0000000000001899.CrossRefPubMed

52.

Neily J, Mills PD, Young-Xu Y, et al. Association between implementation of a medical team training program and surgical mortality. JAMA. 2010;304(15):1693–700. https://www.ncbi.nlm.nih.gov/pubmed/20959579.

53.

Meurisse M, Hamoir E, Defechereux T, et al. Bilateral neck exploration under hypnosedation: a new standard of care in primary hyperparathyroidism? Ann Surg. 1999;229(3):401–8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1191706/pdf/annsurg00003-0115.pdf. Accessed 2 Oct 2017.CrossRefPubMedPubMedCentral

54.

Williamson PR, Altman DG, Bagley H, et al. The COMET handbook: version 1.0. Trials. 2017;18(S3):280. https://doi.org/10.1186/s13063-017-1978-4.CrossRefPubMedPubMedCentral

55.

Grocott M, Myles P, Moonesinghe R, Boney O. Core Outcome Measures in Perioperative and Anaesthetic Care (COMPAC): Core Outcome Measures in Effectiveness Trials Initiative (COMET). 2017 http://www.comet-initiative.org/studies/details/632. Published. Accessed 15 Dec 2017.

56.

Shulman M, Myles P. Measuring perioperative outcome. Curr Opin Anaesthesiol. 2016;29(6):733–8. https://doi.org/10.1097/ACO.0000000000000383.CrossRefPubMed

57.

Myles PS, Grocott MPW, Boney O, et al. Standardizing end points in perioperative trials: towards a core and extended outcome set. Br J Anaesth. 2016;116(5):586–9. https://doi.org/10.1093/bja/aew066.CrossRefPubMed

58.

National Confidential Enquiry into Patient Outcome and Death, Findley G. Knowing the risk: a review of the peri-operative care of surgical patients: summary.; 2011.

59.

McIsaac D, Lavallée LT, van Walraven C. A retrospective assessment of prognostication in 456,685 patients undergoing elective major non-cardiac surgery. Can J Anesth Can d’anesthésie. 2017;64(9):908–18. https://doi.org/10.1007/s12630-017-0909-x.CrossRef

60.

Harsten A, Kehlet H, Toksvig-Larsen S. Recovery after total intravenous general anaesthesia or spinal anaesthesia for total knee arthroplasty: a randomized trial^†. This article is accompanied by editorial IV. Br J Anaesth. 2013;111(3):391–9. https://doi.org/10.1093/bja/aet104.CrossRefPubMed

Title: Anesthesia interventions that alter perioperative mortality: a scoping review
Authors: Sylvain Boet
Cole Etherington
David Nicola
Andrew Beck
Susan Bragg
Ian D. Carrigan
Sarah Larrigan
Cassandra T. Mendonca
Isaac Miao
Tatyana Postonogova
Benjamin Walker
José De Wit
Karim Mohamed
Nadia Balaa
Manoj Mathew Lalu
Daniel I McIsaac
David Moher
Adrienne Stevens
Donald Miller
On behalf of the Perioperative Anesthesia Clinical Trials Group (PACT)
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Systematic Reviews / Issue 1/2018
Electronic ISSN: 2046-4053
DOI: https://doi.org/10.1186/s13643-018-0863-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anesthesia interventions that alter perioperative mortality: a scoping review

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

The effect of carbetocin compared to misoprostol in management of the third stage of labor and prevention of postpartum hemorrhage: a systematic review

Choice of outcomes and measurement instruments in randomised trials on eLearning in medical education: a systematic mapping review protocol

The impact of health literacy on diagnosis and outcomes of symptomatic cancer by ethnicity: a systematic review protocol

Efficacy of the Buzzy® device for pain management of children during needle-related procedures: a systematic review protocol

Mapping evidence on decision-making on contraceptive use among adolescents: a scoping review protocol

Time-to-update of systematic reviews relative to the availability of new evidence