Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Mar 1;277(3):375-380.
doi: 10.1097/SLA.0000000000004954. Epub 2021 May 24.

Routine Postsurgical Anesthesia Visit to Improve 30-day Morbidity and Mortality: A Multicenter, Stepped-wedge Cluster Randomized Interventional Study (The TRACE Study)

TRACE Study Investigators
Collaborators
Randomized Controlled Trial

Routine Postsurgical Anesthesia Visit to Improve 30-day Morbidity and Mortality: A Multicenter, Stepped-wedge Cluster Randomized Interventional Study (The TRACE Study)

TRACE Study Investigators. Ann Surg. .

Abstract

Objective: To study the impact of a standardized postoperative anesthesia visit on 30-day mortality in medium to high-risk elective surgical patients.

Background: Postoperative complications are the leading cause of perioperative morbidity and mortality. Although modified early warning scores (MEWS) were instituted to monitor vital functions and improve postoperative outcome, we hypothesized that complementary anesthesia expertise is needed to adequately identify early deterioration.

Methods: In a prospective, multicenter, stepped-wedge cluster randomized interventional study in 9 academic and nonacademic hospitals in the Netherlands, we studied the impact of adding standardized postoperative anesthesia visits on day 1 and 3 to routine use of MEWS in 5473 patients undergoing elective noncardiac surgery. Primary outcome was 30-day mortality. Secondary outcomes included: incidence of postoperative complications, length of hospital stay, and intensive care unit admission.

Results: Patients were enrolled between October 2016 and August 2018. Informed consent was obtained from 5473 patients of which 5190 were eligible for statistical analyses, 2490 in the control and 2700 in the intervention group. Thirty-day mortality was 0.56% (n = 14) in the control and 0.44% (n = 12) in the intervention group (odds ratio 0.74, 95% Confidence interval 0.34-1.62). Incidence of postoperative complications did not differ between groups except for renal complications which was higher in the control group (1.7% (n = 41) vs 1.0% (n = 27), P = 0.014). Median length of hospital stay did not differ significantly between groups. During the postanesthesia visits, for 16% (n = 437) and 11% (n = 293) of patients recommendations were given on day 1 and 3, respectively, of which 67% (n = 293) and 69% (n = 202) were followed up.

Conclusions: The combination of MEWS and a postoperative anesthesia visit did not reduce 30-day mortality. Whether a postoperative anesthesia visit with strong adherence to the recommendations provided and in a high-risk population might have a stronger impact on postoperative mortality remains to be determined.

Trial registration: Netherlands Trial Registration, NTR5506/ NL5249, https://www.trialregister.nl/trial/5249.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Patient flow diagram.
See this image and copyright information in PMC

Comment in

References

    1. Ghaferi AA Birkmeyer JD Dimick JB Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg. 2009;250:1029–1034. - PubMed
    1. Ghaferi AA Birkmeyer JD Dimick JB Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361:1368–1375. - PubMed
    1. Noordzij PG Poldermans D Schouten O et al. Postoperative mortality in the Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology. 2010;112:1105–1115. - PubMed
    1. Posthuma LM Visscher MJ Hollmann MW et al. Monitoring of high- and intermediate-risk surgical patients. Anesth Analg. 2019;129:1185–1190. - PubMed
    1. Johnston MJ Arora S King D et al. A systematic review to identify the factors that affect failure to rescue and escalation of care in surgery. Surgery. 2015;157:752–763. - PubMed

Publication types