Postoperative serious-adverse-events in older patients at three Melbourne hospitals (The POSTOP project)

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McNicol PL.^1,4, Story D.^1,4, Leslie K.^2,5 , Myles P.^3,6 , Shelton A.¹, McMullin C.², Major R.³ , Poustie S.^1,5
1. Department of Anaesthesia, Austin Health, Melbourne; 2. Department of Anaesthesia, Royal Melbourne Hospital, Melbourne; 3. Department of Anaesthesia and Pain Management, The Alfred, Melbourne; 4. Department of Surgery, University of Melbourne, Austin Health, Melbourne; 5. Department of Pharmacology, University of Melbourne, Melbourne; 6. Department of Epidemiology & Preventive Medicine, Monash University, Melbourne

Purpose of Study

Previous studies at the Austin Hospital have found a high incidence of postoperative serious-adverse-events (23 to 30/100 patients) that may be reduced with targeted intervention¹. We tested the hypothesis that a multicentre study of large Melbourne hospitals would show a similar incidence of serious-adverse-events.

Method

Following approval by Human Research Ethics Committees we studied all patients aged 70 years or older at three large Melbourne hospitals (Austin, Royal Melbourne (RMH), and Alfred) who stayed at least one postoperative night during September to November 2004. We collected data on serious-adverse-events¹ in patients after all types of surgery both scheduled and unscheduled. Data were collected for the first five postoperative days as well as 28 day mortality.

Result

With data from 1000 of 1100 patients (402 Austin, 401 RMH, 197 Alfred), 186 patients (19%) had at least one serious-adverse-event and 24 died within the first five postoperative days. There were 314 serious-adverse-events. The overall rate of serious-adverse-events was 31 per 100 patients. Two thirds of the serious-adverse-events occurred on the general wards and one third in intensive care or high dependency. The most frequent serious-adverse-events were acute renal impairment (7/100 patients), sepsis (5/100 patients), and acute pulmonary oedema (4/100 patients).

Discussion

In this multicentre study we found a similar incidence of serious-adverse-events to previous Austin studies. We suggest that other large hospitals across Australasia may have high incidences of serious-adverse-events in older patients. The high incidence of acute renal impairment and acute pulmonary oedema suggests that perioperative monitoring and fluid management warrants further study.

Time of Presentation
Saturday 7 May 2005 - 1530-1700

References

1. Story DA, Shelton AC, Poustie SJ, McNicol PL. The effect of critical care outreach on postoperative serious adverse events. Anaesthesia. 2004; 59:762-766.