11 research outputs found
A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: A secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study
- Author
- Abolfathi M.
- Ackland G.L.
- Ahmad T.
- Ali M.
- Allen S.
- Ami N.
- Andrews L.
- Au S.
- Back G.
- Bates S.
- Beattie W.S.
- Beauchamp N.
- Beilstein C.
- Belliard R.
- Black E.
- Bodger A.
- Bodger P.
- Bolger C.
- Borg B.
- Bramley D.
- Brannan J.
- Brown A.
- Brull R.
- Brunello K.
- Campbell D.
- Carrera A.M.
- Celinski M.
- Chan V.
- Choi S.
- Clarke H.A.
- Collingwood A.
- Collins H.
- Corriea C.
- Creary T.
- Crescini C.
- Cuthbertson B.H.
- Dalley P.
- Day L.
- Dent A.
- Dimech J.
- Dobson K.
- Douglas J.
- Edwards M.
- Elliott A.
- Ellis M.
- Everingham K.
- Filipe H.
- Flores K.
- Gabriel S.
- Gallego-Paredes L.
- Gertsman M.
- Godsall M.G.
- Golder K.
- Grant J.
- Greaves K.
- Gurunathan U.
- Gutierrez del Arroyo A.
- Hagen K.
- Hall A.
- Haslop R.
- Higgie J.K.
- Hillis G.
- Ho K.M.
- Houston H.
- Hu Y.
- Hunt A.
- Hurford S.
- Ismail H.
- Ismail H.
- Jack S.
- Jang R.
- Januszewska M.
- Jason-Smith A.
- Jerath A.
- Jhanji S.
- Karkouti K.
- Kenchington K.
- Kennedy A.
- Kerridge R.K.
- Kim C.
- Kirabiyik Y.
- Koutra M.
- Kumar J.
- Kunasingam J.
- Kynaston S.
- Lawrence H.
- Lee C.H.A.
- Lee L.
- Leslie K.
- Levett D.
- Li M.H-G
- Lifford R.
- Lindsay H.
- Lorimer M.
- Loughney L.
- Lum M.
- MacCormick A.
- MacDonald N.
- Macklin S.
- Malherbe J.
- Mamdani M.
- Marshall F.
- Martin D.
- Masel P.
- Mazer C.D.
- Mcallister D.
- McCartney C.J.L.
- McCluskey S.A.
- McMillan N.
- McNeil J.
- Melo M.
- Melville A.
- Miller R.
- Murmane A.
- Navarra L.
- Niebrzegowska E.
- Oh P.
- Olliff S.
- Painter T.W.
- Pakats M.
- Pazmino-Canizares J.
- Phull M.
- Pinto M.
- Pirie K.
- Pitt S.
- Pretto J.
- Raj A.
- Raobaikady R.
- Reyes A.
- Riedel B.
- Riedel B.
- Rooms M.
- S James S.
- Salmon K.
- Samuels J.
- Sara R.
- Seaward L.
- Short T.
- Sivakumar H.
- Sivalingam P.
- Smith E.
- Somascanthan P.
- Southcott A.M.
- Stanbrook M.
- Steele K.
- Stephens R.C.M.
- Stonell C.
- Tai J.
- Tantony N.
- Taylor H.
- Terblanche N.C.S.
- Thompson B.
- Thompson H.
- Tippett A.
- Towns M.
- Tronstad O.
- Tyrell B.
- Van Der Westhuizen J.
- Wallace S.
- Wasowicz M.
- Waymouth E.
- Whalley J.
- Wijeysundera D.N.
- Wijeysundera H.C.
- Wilde C.
- Wong C.
- Wright E.
- Yagnik A.
- Yagnik S.
- Publication venue
- 'Oxford University Press (OUP)'
- Publication date
- 01/01/2020
- Field of study
Background
Accurate assessment of functional capacity, a predictor of postoperative morbidity and mortality, is essential to improving surgical planning and outcomes. We assessed if all 12 items of the Duke Activity Status Index (DASI) were equally important in reflecting exercise capacity.
Methods
In this secondary cross-sectional analysis of the international, multicentre Measurement of Exercise Tolerance before Surgery (METS) study, we assessed cardiopulmonary exercise testing and DASI data from 1455 participants. Multivariable regression analyses were used to revise the DASI model in predicting an anaerobic threshold (AT) >11 ml kg −1 min −1 and peak oxygen consumption (VO 2 peak) >16 ml kg −1 min −1, cut-points that represent a reduced risk of postoperative complications.
Results
Five questions were identified to have dominance in predicting AT>11 ml kg −1 min −1 and VO 2 peak>16 ml.kg −1min −1. These items were included in the M-DASI-5Q and retained utility in predicting AT>11 ml.kg −1.min −1 (area under the receiver-operating-characteristic [AUROC]-AT: M-DASI-5Q=0.67 vs original 12-question DASI=0.66) and VO 2 peak (AUROC-VO2 peak: M-DASI-5Q 0.73 vs original 12-question DASI 0.71). Conversely, in a sensitivity analysis we removed one potentially sensitive question related to the ability to have sexual relations, and the ability of the remaining four questions (M-DASI-4Q) to predict an adequate functional threshold remained no worse than the original 12-question DASI model. Adding a dynamic component to the M-DASI-4Q by assessing the chronotropic response to exercise improved its ability to discriminate between those with VO 2 peak>16 ml.kg −1.min −1 and VO 2 peak<16 ml.kg −1.min −1.
Conclusions
The M-DASI provides a simple screening tool for further preoperative evaluation, including with cardiopulmonary exercise testing, to guide perioperative management
Integration of the Duke Activity Status Index into preoperative risk evaluation: a multicentre prospective cohort study.
- Author
- Abbott TEF
- Abbott TEF
- Abolfathi M
- Ackland GL
- Ackland GL
- Ahmad T
- Ali M
- Allen S
- Ami N
- Andrews L
- Back G
- Bates S
- Beattie WS
- Beattie WS
- Beauchamp N
- Beilstein C
- Belliard R
- Black E
- Bodger A
- Bodger P
- Bolger C
- Borg B
- Bramley D
- Brannan J
- Brown A
- Brull R
- Brunello K
- Campbell D
- Carrera AM
- Celinski M
- Central Project Office Operations Committee
- Chan V
- Choi S
- Clarke HA
- Collingwood A
- Collins H
- Corriea C
- CPET Methods Committee
- Creary T
- Crescini C
- Croal BL
- Cuthbertson BH
- Dalley P
- Day L
- Dent A
- Dimech J
- Dobson K
- Douglas J
- Edwards M
- Elliott A
- Ellis M
- Everingham K
- Farrington C
- Filipe H
- Flores K
- Gabriel S
- Gallego-Paredes L
- Gertsman M
- Godsall MG
- Golder K
- Grant J
- Granton JT
- Greaves K
- Gurunathan U
- Gutierrez Del Arroyo A
- Hagen K
- Hall A
- Haslop R
- Higgie K
- Hillis GS
- Houston H
- Hu Y
- Hunt A
- Hurford S
- International and National Coordinators
- International Steering Committee
- Ismail H
- Jack S
- James S
- Jang R
- Januszewska M
- Jason-Smith A
- Jerath A
- Jhanji S
- Karkouti K
- Kenchington K
- Kennedy A
- Kerridge RK
- Kim C
- Kirabiyik Y
- Koutra M
- Kumar J
- Kunasingam J
- Kynaston S
- Lawrence H
- Lee L
- Leslie K
- Levett D
- Lifford R
- Lindsay H
- Lorimer M
- Loughney L
- Lum M
- MacCormick A
- MacDonald N
- Macklin S
- Malherbe J
- Marshall F
- Martin D
- Masel P
- Mazer CD
- Mazer CD
- Mcallister D
- McCartney CJL
- McCluskey SA
- McMillan N
- McNeil J
- Measurement of Exercise Tolerance before Surgery Study Investiga
- Melville A
- Miller R
- Murmane A
- Myles PS
- Myles PS
- Navarra L
- Niebrzegowska E
- Oh P
- Olliff S
- Outcome Adjudication Committee
- Painter TW
- Pakats M
- Pazmino-Canizares J
- Pearse RM
- Pearse RM
- Phull M
- Pinto M
- Pirie K
- Pitt S
- Pretto J
- Raj A
- Raobaikady R
- Reyes A
- Riedel B
- Rooms M
- Salmon K
- Samuels J
- Sara R
- Seaward L
- Short T
- Shulman MA
- Shulman MA
- Sivakumar H
- Sivalingam P
- Smith E
- Somascanthan P
- Southcott AM
- Stanbrook M
- Steele K
- Stephens RCM
- Stonell C
- Tai J
- Tantony N
- Taylor H
- Terblanche NCS
- Thompson B
- Thompson H
- Tippett A
- Towns M
- Tronstad O
- Tyrell B
- Van Der Westhuizen J
- Wallace S
- Wasowicz M
- Waymouth E
- Whalley J
- Wijeysundera DN
- Wijeysundera DN
- Wilde C
- Wong C
- Wright E
- Yagnik A
- Yagnik S
- Publication venue
- 'Elsevier BV'
- Publication date
- 01/03/2020
- Field of study
BACKGROUND: The Duke Activity Status Index (DASI) questionnaire might help incorporate self-reported functional capacity into preoperative risk assessment. Nonetheless, prognostically important thresholds in DASI scores remain unclear. We conducted a nested cohort analysis of the Measurement of Exercise Tolerance before Surgery (METS) study to characterise the association of preoperative DASI scores with postoperative death or complications. METHODS: The analysis included 1546 participants (≥40 yr of age) at an elevated cardiac risk who had inpatient noncardiac surgery. The primary outcome was 30-day death or myocardial injury. The secondary outcomes were 30-day death or myocardial infarction, in-hospital moderate-to-severe complications, and 1 yr death or new disability. Multivariable logistic regression modelling was used to characterise the adjusted association of preoperative DASI scores with outcomes. RESULTS: The DASI score had non-linear associations with outcomes. Self-reported functional capacity better than a DASI score of 34 was associated with reduced odds of 30-day death or myocardial injury (odds ratio: 0.97 per 1 point increase above 34; 95% confidence interval [CI]: 0.96-0.99) and 1 yr death or new disability (odds ratio: 0.96 per 1 point increase above 34; 95% CI: 0.92-0.99). Self-reported functional capacity worse than a DASI score of 34 was associated with increased odds of 30-day death or myocardial infarction (odds ratio: 1.05 per 1 point decrease below 34; 95% CI: 1.00-1.09), and moderate-to-severe complications (odds ratio: 1.03 per 1 point decrease below 34; 95% CI: 1.01-1.05). CONCLUSIONS: A DASI score of 34 represents a threshold for identifying patients at risk for myocardial injury, myocardial infarction, moderate-to-severe complications, and new disability
Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.
- Author
- Ab Majid MA
- Ab Rahman AS
- Ab Rahman R
- Abayasinghe C
- Abbott T
- Abdullah NH
- Abdur-Rahman L
- Abeloos J
- Abernethy C
- Abidin UN
- Abrunhosa A
- Absar M
- Adam S
- Adams D
- Adams G
- Adamson M
- Adekola O
- Adelaja Y
- Ademola A
- Adenekan A
- Adenike O
- Adeolu AA
- Adetoye A
- Adewale B
- Adigun T
- Adolfsson A
- Aflori L
- Africander C
- Afshari A
- Agarwal V
- Agodirin O
- Aguero Vera M
- Aguzzoli C
- Ahmad A
- Ahmad N
- Ahmad T
- Ahmad T
- Ahmad Y
- Ahmed A
- Ahmed J
- Ai Y
- Aignatoaie M
- Aimoniotou-Georgiou E
- Akanmu O
- Akerman N
- Akinwale M
- Akring I
- Al 'Amri K
- Al Anizi M
- Al hussaini S
- Al-Soudaine Y
- Aladin H
- Alagbe-Briggs O
- Alaman Laguarda G
- Albaj S
- Alcock D
- Alcock L
- Aldecoa C
- Aldecoa C
- Aleixo FB
- Alexander H
- Alexander M
- Alexander-Sefre F
- Alherz F
- Ali H
- Ali M
- Ali S
- Alias A
- Alias AH
- Alias RLR
- Alit MA
- Allen S
- Allen SJ
- Allison J
- Alloj C
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- Allsop J
- Almeida W
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- Applewhaite C
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- Arawwawala D
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- Arnold G
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- Arrich J
- Arrigo M
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- Arya A
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- Asimakos A
- Asudo F
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- Utara UH
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- Vahedi A
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- Vakalos A
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- van den Berg B
- Van Den Eynde N
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- van Duivenvoorde Y
- Van Duyvenvoorde G
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- Van Limmen J
- Van Mossevelde V
- van Rossum S
- van Vuuren AJ
- van Wyk S
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- van Zeggeren L
- van Zundert T
- van Zyl R
- Vandenbempt P
- Vandenheuvel M
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- Verdoodt H
- Veroniki F
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- Vilela dos Santos AM
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- Vohra A
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- Wallet F
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- Walsh D
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- Waymouth E
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- Weatherill J
- Webb S
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- Wendling PR
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- Weyland A
- White S
- White S
- whitehouse A
- Whitman Z
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- Wigmore G
- Wijeysundera D
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- Wilscott-Davids C
- Wilson A
- Wilson D
- Wilson L
- Wilson N
- Wima S
- Winch D
- Winstone U
- Winterton D
- Wir WM
- Wise R
- Wittmann M
- Wolfer A
- Wollaston J
- Wong C
- Wong CW
- Wong JY
- Wong K
- Wong KWK
- Wong SM
- Wong T
- Wong WL
- Woodgate A
- Woolsey A
- Woon YL
- Worreth M
- Wouters P
- Wrench I
- Wright S
- Wu C
- Wu C
- Wu J
- Wu J
- Wu Q
- Wu S
- Wyffels P
- Wylie K
- Xia J
- Xia Y
- Xia Z-Y
- Xiao W
- Xiao W
- Xie G
- Xie J
- Xie J
- Xie K
- Xifara A
- Xiong X
- Xiong Y
- Xouplidis K
- Xu G-J
- Xu L
- Xu L
- Xu Q
- Xu S
- Xue R
- Yagnik A
- Yan Y
- Yang J
- Yang L
- Yang Q
- Yang S
- Yang T
- Yang Y
- Yao S
- Yao Y
- Yap HL
- Yarwood J
- Yassaee A
- Ye H
- Ye H
- Yegnaram S
- Yeh E
- Yin N
- Yip CP
- Yong J
- Yu HC
- Yu S
- Yu T
- Yu Y
- Yuan D
- Yuan F
- Yuan J
- Yuan J
- Yuan Y
- Yuliana A
- Zaimi D
- Zakynthinos S
- Zamudio D
- Zangrillo A
- Zapata DDM
- Zbitnew G
- Zeidan L
- Zeng Q
- Zerman L
- Zettergren J
- Zhang B
- Zhang E
- Zhang H
- Zhang H
- Zhang H
- Zhang J
- Zhang K
- Zhang L
- Zhang M
- Zhang M
- Zhang Q
- Zhang R
- Zhang S
- Zhang W
- Zhang X
- Zhang X
- Zhang X
- Zhang X
- Zhang Y
- Zhang Y
- Zhang Y
- Zhang Y
- Zhao B
- Zhao B
- Zhao C
- Zhao J
- Zhao J
- Zhao L
- Zhao L
- Zhao S
- Zhao T
- Zhao W
- Zhao W
- Zhao X
- Zhen J
- Zheng K
- Zheng L
- Zheng T
- Zhong Y
- Zhou C
- Zhou D
- Zhou H
- Zhou H
- Zhou J
- Zhou J
- Zhou J
- Zhou X-J
- Zhu X
- Zhu X
- Zhu Y
- Zhu Z
- Zhuang X
- Zilis G
- Zin NHM
- Zingerle N
- Zingg U
- Zoerner F
- Zonneveldt H
- Zou X
- Zoulamoglou M
- Zsisku L
- Publication venue
- 'Oxford University Press (OUP)'
- Publication date
- 01/01/2016
- Field of study
BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700
Heart rate recovery and morbidity after noncardiac surgery: Planned secondary analysis of two prospective, multi-centre, blinded observational studies
- Author
- Abbott TEF
- Abbott TEF
- Abolfathi M
- Ackland GL
- Ackland GL
- Ahmad T
- Ali M
- Allen S
- Ami N
- Andrews L
- Back G
- Bates S
- Beattie WS
- Beauchamp N
- Beilstein C
- Belliard R
- Black E
- Bodger A
- Bodger P
- Bolger C
- Borg B
- Bramley D
- Brannan J
- Brown A
- Brull R
- Brunello K
- Campbell D
- Carrera AM
- Celinski M
- Chan V
- Choi S
- Clark M
- Clarke HA
- Collingwood A
- Collins H
- Corriea C
- Creary T
- Crescini C
- Croal BL
- Cuthbertson BH
- Dalley P
- Day L
- del Arroyo AG
- del Arroyo AG
- Dent A
- Dimech J
- Dobson K
- Douglas J
- Edwards M
- Elliott A
- Ellis M
- Everingham K
- Farrington C
- Filipe H
- Flores K
- Gabriel S
- Gallego-Paredes L
- Gertsman M
- Godsall MG
- Golder K
- Grant J
- Granton JT
- Greaves K
- Green R
- Gurunathan U
- Hagen K
- Hall A
- Haslop R
- Higgie K
- Houston H
- Hu Y
- Hull D
- Hunt A
- Hurford S
- Investigators METSS
- Investigators POM-HRS
- Ismail H
- Jack S
- James S
- Jang R
- Januszewska M
- Jason-Smith A
- Jerath A
- Jhanji S
- Jones A
- Karkouti K
- Kenchington K
- Kennedy A
- Kerridge RK
- Kim C
- King A
- Kirabiyik Y
- Koutra M
- Kumar J
- Kunasingam J
- Kynaston S
- Lach A
- Lawrence H
- Lee L
- Leslie K
- Levett D
- Lifford R
- Lindsay H
- Lorimer M
- Loughney L
- Lum M
- MacCormick A
- MacDonald N
- Macklin S
- Malherbe J
- Marshall F
- Martin D
- Masel P
- May SM
- May SM
- Mazer CD
- Mcallister D
- McCartney CJL
- McCluskey SA
- McMillan N
- McNeil J
- Melville A
- Miller R
- Minto G
- Montague L
- Murmane A
- Myles PS
- Navarra L
- Niebrzegowska E
- Oh P
- Olliff S
- Otto J
- Owen T
- Painter TW
- Pakats M
- Paredes LG
- Patrick A
- Pazmino-Canizares J
- Pearse RM
- Pearse RM
- Phull M
- Pinto M
- Pirie K
- Pitt S
- Pollak C
- Prabhu P
- Pradhu P
- Pretto J
- Raj A
- Raobaikady R
- Reyes A
- Reyes A
- Reynolds JA
- Reynolds JA
- Riedel B
- Rooms M
- Salmon K
- Samuels J
- Sara R
- Seaward L
- Short T
- Shulman MA
- Sivakumar H
- Sivalingam P
- Smith E
- Somascanthan P
- Southcott AM
- Stanbrook M
- Steele K
- Stephens RCM
- Stephens RCM
- Stonell C
- Tai J
- Tantony N
- Taylor H
- Terblanche NCS
- Thompson B
- Thompson H
- Tippett A
- Toner A
- Towns M
- Tronstad O
- Tyrell B
- Van Der Westhuizen J
- Vickers E
- Wallace S
- Wasowicz M
- Waymouth E
- West C
- Whalley J
- Whittle J
- Wijesundera D
- Wijeysundera DN
- Wilde C
- Williams A
- Williams C
- Wong C
- Wright E
- Yagnik A
- Yagnik S
- Publication venue
- 'Public Library of Science (PLoS)'
- Publication date
- 01/01/2019
- Field of study
BackgroundImpaired cardiac vagal function, quantified preoperatively as slower heart rate recovery (HRR) after exercise, is independently associated with perioperative myocardial injury. Parasympathetic (vagal) dysfunction may also promote (extra-cardiac) multi-organ dysfunction, although perioperative data are lacking. Assuming that cardiac vagal activity, and therefore heart rate recovery response, is a marker of brainstem parasympathetic dysfunction, we hypothesized that impaired HRR would be associated with a higher incidence of morbidity after noncardiac surgery.MethodsIn two prospective, blinded, observational cohort studies, we established the definition of impaired vagal function in terms of the HRR threshold that is associated with perioperative myocardial injury (HRR ≤ 12 beats min-1 (bpm), 60 seconds after cessation of cardiopulmonary exercise testing. The primary outcome of this secondary analysis was all-cause morbidity three and five days after surgery, defined using the Post-Operative Morbidity Survey. Secondary outcomes of this analysis were type of morbidity and time to become morbidity-free. Logistic regression and Cox regression tested for the association between HRR and morbidity. Results are presented as odds/hazard ratios [OR or HR; (95% confidence intervals).Results882/1941 (45.4%) patients had HRR≤12bpm. All-cause morbidity within 5 days of surgery was more common in 585/822 (71.2%) patients with HRR≤12bpm, compared to 718/1119 (64.2%) patients with HRR>12bpm (OR:1.38 (1.14-1.67); p = 0.001). HRR≤12bpm was associated with more frequent episodes of pulmonary (OR:1.31 (1.05-1.62);p = 0.02)), infective (OR:1.38 (1.10-1.72); p = 0.006), renal (OR:1.91 (1.30-2.79); p = 0.02)), cardiovascular (OR:1.39 (1.15-1.69); pConclusionsMulti-organ dysfunction is more common in surgical patients with cardiac vagal dysfunction, defined as HRR ≤ 12 bpm after preoperative cardiopulmonary exercise testing.Clinical trial registryISRCTN88456378
Using the 6-minute walk test to predict disability-free survival after major surgery
- Author
- A. Ambosta
- A. Bodger
- A. Collingwood
- A. Dent
- A. Elliott
- A. Hall
- A. Hunt
- A. Jason-Smith
- A. Jerath
- A. Kennedy
- A. MacCormick
- A. Melville
- A. Murmane
- A. Tippett
- A.M. Carrera
- A.M. Southcott
- American Thoracic Society American College of Chest Physicians
- Awdeh
- B. Borg
- B. Riedel
- B. Thompson
- B. Thompson
- B.H. Cuthbertson
- Bois du
- C. Farrington
- C. Kim
- C. Stonell
- C. Wilde
- C. Wong
- C.J.L. McCartney
- Cahalin
- Cohen
- D. Bramley
- D. Campbell
- D. Mcallister
- D.N. Wijeysundera
- E. Smith
- E. Torres
- E. Waymouth
- E. Wright
- F. Marshall
- Fleisher
- G. Back
- G. Hillis
- H. Houston
- H. Ismail
- H. Lindsay
- H. Sivakumar
- H. Taylor
- H. Thompson
- H.A. Clarke
- H.C. Wijeysundera
- Hlatky
- J. Brannan
- J. Dimech
- J. Douglas
- J. Grant
- J. Kumar
- J. Malherbe
- J. Pazmino-Canizares
- J. Pretto
- J. Samuels
- J. Tai
- J. Van Der Westhuizen
- J.T. Granton
- K. Brunello
- K. Flores
- K. Hagen
- K. Higgie
- K. Karkouti
- K. Kenchington
- K. Leslie
- K. Steele
- Kalkman
- Keeratichananont
- Kristensen
- L. Andrews
- L. Day
- L. Navarra
- Lai
- Lee
- M. Abolfathi
- M. Ali
- M. Ellis
- M. Lorimer
- M. Mamdani
- M. Melo
- M. Towns
- M. Wasowicz
- M.A. Shulman
- M.G. Godsall
- Myles
- Myles
- N. Beauchamp
- N. McMillan
- N.C.S. Terblanche
- O. Tronstad
- P. Dalley
- P. Masel
- P. Sivalingam
- P. Somascanthan
- P.S. Myles
- Paisani
- Polkey
- R. Jang
- R. Miller
- R. Sara
- R.K. Kerridge
- R.M. Pearse
- Rodseth
- S. Allen
- S. Bates
- S. Choi
- S. Gabriel
- S. Hurford
- S. Macklin
- S. Olliff
- S. Pitt
- S. Wallace
- S. Wallace
- S.A. McCluskey
- Shulman
- Shulman
- Sinclair
- Stark
- Szekely
- T. Painter
- T. Short
- U. Gurunathan
- W.S. Beattie
- Wijeysundera
- Wijeysundera
- Wu
- Zugck
- Publication venue
- 'Elsevier BV'
- Publication date
- Field of study
Assessment of functional capacity before major non-cardiac surgery: an international, prospective cohort study.
- Author
- Abbott Tom E F
- Abolfathi Miriam
- Ackland Gareth L
- Ahmad Tahania
- Ali Marlynn
- Allen Sandra
- Ambosta Althea
- Ami Noam
- Andrews Lynn
- Au Shelly
- Back Geraldine
- Bates Samantha
- Beattie W Scott
- Beauchamp Nicola
- Beilstein Christian
- Belliard Rene
- Black Ethel
- Bodger Alanna
- Bodger Pheobe
- Bolger Clare
- Borg Brigette
- Bramley David
- Brannan John
- Brown Alistair
- Brull Richard
- Brunello Kate
- Campbell Douglas
- Carrera Anna Maria
- Celinski Michael
- Chan Vincent
- Choi Stephen
- Clarke Hance A
- Collingwood Andrew
- Collins Hannah
- Corriea Carmen
- Creary Thais
- Crescini Charmagne
- Croal Bernard L
- Cuthbertson Brian H
- Dalley Paul
- Day Lauren
- Dent Annette
- Dimech Julian
- Dobson Karen
- Douglas Jeanene
- Edwards Mark
- Elliott Adrian
- Ellis Mathew
- Everingham Kirsty
- Farrington Catherine
- Filipe Helder
- Flores Kathrina
- Gabriel Sharon
- Gallego-Paredes Laura
- Gertsman Michelle
- Godsall Guy
- Golder Kim
- Grant John
- Granton John T
- Greaves Kathryn
- Grocott Michael P W
- Gurunathan Usha
- Gutierrez del Arroyo Ana
- Hagen Katherine
- Hall Adrian
- Haslop Richard
- Higgie Kushlin
- Hillis Graham
- Houston Helen
- Hu Ying
- Hunt Anna
- Hurford Sally
- Ismail Hilmy
- Jack Sandy
- James Sarah
- Jang Ryan
- Januszewska Marta
- Jason-Smith Adelaide
- Jerath Angela
- Jhanji Shaman
- Karkouti Keyvan
- Kenchington Kay
- Kennedy Ann
- Kerridge Ross K
- Kim Chang Joon
- Kirabiyik Yesim
- Koutra Maria
- Kumar Jonathan
- Kunasingam Janarthanee
- Kynaston Stephen
- Lawrence Helen
- Lee Leanna
- Leslie Kate
- Levett Denny
- Lifford Rhiannon
- Lindsay Helen
- Lorimer Michael
- Loughney Lisa
- Lum Mark
- MacCormick Andrew
- MacDonald Neil
- Macklin Simon
- Malherbe Johan
- Mamdani Muhammad
- Marshall Fiona
- Martin Daniel
- Masel Philip
- Mazer C David
- McAllister Davina
- McCartney Colin JL
- McCluskey Stuart A
- McMillan Natalie
- McNeil Jane
- Melo Magda
- Melville Andrew
- Miller Reuben
- Murmane Andrew
- Myles Paul S
- Navarra Leanlove
- Niebrzegowska Edyta
- Oh Paul
- Olliff Sue
- Painter Thomas W
- Pakats Mari Liis
- Pazmino-Canizares Janneth
- Pearse Rupert M
- Phull Mandeep
- Pinto Manuel
- Pirie Katrina
- Pitt Simon
- Pretto Jeff
- Raj Ashok
- Raobaikady Ravishanar
- Reyes Anna
- Riedel Bernhard
- Rooms Martin
- Salmon Karen
- Samuel Joanne
- Sara Rachel
- Seaward Leanne
- Short Timothy
- Shulman Mark A
- Sivakumar Harry
- Sivalingam Pal
- Smith Emma
- Somascanthan Priya
- Southcott Anne Marie
- Stanbrook Matthew
- Steele Katherine
- Stephens RCM
- Stonell Chris
- Tai Joyce
- Tantony Natasha
- Taylor Hugh
- Terblanche Nico CS
- Thompson Bruce
- Thompson Helen
- Thorpe Kevin E
- Tippett Anna
- Torres Elizabeth
- Towns Miriam
- Tronstad Oystein
- Tyrell Bryony
- Van Der Westhuizen Joreline
- Wallace Sophie
- Wasowicz Marcin
- Waymouth Ellen
- Whalley Jan
- Wijeysundera Duminda N
- Wijeysundera Harindra C
- Wilde Chris
- Wong Chris
- Wright Ewan
- Yagnik Anmol
- Yagnik Sanjay
- Publication venue
- 'Elsevier BV'
- Publication date
- 04/06/2018
- Field of study
BACKGROUND: Functional capacity is an important component of risk assessment for major surgery. Doctors' clinical subjective assessment of patients' functional capacity has uncertain accuracy. We did a study to compare preoperative subjective assessment with alternative markers of fitness (cardiopulmonary exercise testing [CPET], scores on the Duke Activity Status Index [DASI] questionnaire, and serum N-terminal pro-B-type natriuretic peptide [NT pro-BNP] concentrations) for predicting death or complications after major elective non-cardiac surgery. METHODS: We did a multicentre, international, prospective cohort study at 25 hospitals: five in Canada, seven in the UK, ten in Australia, and three in New Zealand. We recruited adults aged at least 40 years who were scheduled for major non-cardiac surgery and deemed to have one or more risk factors for cardiac complications (eg, a history of heart failure, stroke, or diabetes) or coronary artery disease. Functional capacity was subjectively assessed in units of metabolic equivalents of tasks by the responsible anaesthesiologists in the preoperative assessment clinic, graded as poor (10). All participants also completed the DASI questionnaire, underwent CPET to measure peak oxygen consumption, and had blood tests for measurement of NT pro-BNP concentrations. After surgery, patients had daily electrocardiograms and blood tests to measure troponin and creatinine concentrations until the third postoperative day or hospital discharge. The primary outcome was death or myocardial infarction within 30 days after surgery, assessed in all participants who underwent both CPET and surgery. Prognostic accuracy was assessed using logistic regression, receiver-operating-characteristic curves, and net risk reclassification. FINDINGS: Between March 1, 2013, and March 25, 2016, we included 1401 patients in the study. 28 (2%) of 1401 patients died or had a myocardial infarction within 30 days of surgery. Subjective assessment had 19·2% sensitivity (95% CI 14·2-25) and 94·7% specificity (93·2-95·9) for identifying the inability to attain four metabolic equivalents during CPET. Only DASI scores were associated with predicting the primary outcome (adjusted odds ratio 0·96, 95% CI 0·83-0·99; p=0·03). INTERPRETATION: Subjectively assessed functional capacity should not be used for preoperative risk evaluation. Clinicians could instead consider a measure such as DASI for cardiac risk assessment. FUNDING: Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University.This study was supported by grants from the Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research, Innovation and Science, UK National Institute of Academic Anaesthesia, UK Clinical Research Collaboration, Australian and New Zealand College of Anaesthetists, and Monash University (Melbourne, VIC, Australia). DNW is supported by a New Investigator Award from the Canadian Institutes of Health Research. DNW and BHC are partly supported by Merit Awards from the Department of Anesthesia at the University of Toronto. RMP is a Career Development Fellow for the British Journal of Anaesthesia and Royal College of Anaesthetists, and a professor for the UK National Institute for Health Research. TEFA is a clinical research training fellow for the UK Medical Research Council and British Journal of Anaesthesia. MPWG holds the British Oxygen Company Chair of Anaesthesia of the Royal College of Anaesthetists, which is awarded by the UK National Institute of Academic Anaesthesia. We thank the Li Ka Shing Knowledge Institute of St Michael's Hospital (Toronto, ON, Canada) for generously supporting the costs of international trial insurance for this study, and all the participating patients and staff across the 25 study sites
Kuluttajabarometri maakunnittain 2000, 2. neljännes
- Author
- Ab Majid MA
- Ab Rahman AS
- Ab Rahman R
- Abayasinghe C
- Abbott T
- Abdullah NH
- Abdur-Rahman L
- Abeloos J
- Abernethy C
- Abidin UN
- Abrunhosa A
- Absar M
- Adam S
- Adams D
- Adams G
- Adamson M
- Adekola O
- Adelaja Y
- Ademola A
- Adenekan A
- Adenike O
- Adeolu AA
- Adetoye A
- Adewale B
- Adigun T
- Adolfsson A
- Aflori L
- Africander C
- Afshari A
- Agarwal V
- Agodirin O
- Aguero Vera M
- Aguzzoli C
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- Aignatoaie M
- Aimoniotou-Georgiou E
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- Akerman N
- Akinwale M
- Akring I
- Al 'Amri K
- Al Anizi M
- Al hussaini S
- Al-Soudaine Y
- Aladin H
- Alagbe-Briggs O
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- Zamudio D
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- Zbitnew G
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- Zin NHM
- Zingerle N
- Zingg U
- Zoerner F
- Zonneveldt H
- Zou X
- Zoulamoglou M
- Zsisku L
- Publication venue
- Tilastokeskus
- Publication date
- 11/07/2000
- Field of study
Suomen virallinen tilasto (SVT
Use of failure-to-rescue to identify international variation in postoperative care in low-, middle- and high-income countries: a 7-day cohort study of elective surgery
- Author
- Ab Majid MA
- Ab Rahman AS
- Ab Rahman R
- Abayasinghe C
- Abbott T
- Abdullah NH
- Abdur-Rahman L
- Abeloos J
- Abernethy C
- Abidin UN
- Abrunhosa A
- Absar M
- Adam S
- Adams D
- Adams G
- Adamson M
- Adekola O
- Adelaja Y
- Ademola A
- Adenekan A
- Adenike O
- Adeolu AA
- Adetoye A
- Adewale B
- Adigun T
- Adolfsson A
- Aflori L
- Africander C
- Afshari A
- Agarwal V
- Agodirin O
- Aguero Vera M
- Aguzzoli C
- Ahmad A
- Ahmad N
- Ahmad T
- Ahmad T
- Ahmad Y
- Ahmed A
- Ahmed J
- Ai Y
- Aignatoaie M
- Aimoniotou-Georgiou E
- Akanmu O
- Akerman N
- Akinwale M
- Akring I
- Al 'Amri K
- Al Anizi M
- Al hussaini S
- Al-Soudaine Y
- Aladin H
- Alagbe-Briggs O
- Alaman Laguarda G
- Albaj S
- Alcock D
- Alcock L
- Aldecoa C
- Aldecoa C
- Aleixo FB
- Alexander H
- Alexander M
- Alexander-Sefre F
- Alherz F
- Ali H
- Ali M
- Ali S
- Alias A
- Alias AH
- Alias RLR
- Alit MA
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- Allen SJ
- Allison J
- Alloj C
- Allorto NL
- Allsop J
- Almeida W
- Alonso E
- Alphonsus C
- Alvares D
- Alves MJ
- Amador JCB
- Ameer Y
- Amendola CP
- Ami N
- Amstrup-Hansen L
- Anagnou A
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- Anderson C
- Anderson F
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- Andreadaki E
- Andreou A
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- Anillo V
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- Cherian R
- Cherrett V
- Chetty RR
- Chew M
- Chhabra A
- Chicken D-W
- Chilinciuc I
- Chin II
- Chirkut S
- Chisbert Cuenca V
- Chlorou D
- Choi H-MD
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- Christiansen IC
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- Christoforidis D
- Chronis C
- Chu HM
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- Chung CKE
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- Ciobotaru OR
- Cirstea E
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- Clyde A
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- Codita A
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- Comptaer N
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- Dumitrascu CO
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- Waymouth E
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- Weatherill J
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- whitehouse A
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- Whitworth H
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- Wickboldt N
- Wickenhauser R
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- Wighton E
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- Wijeysundera D
- Wikner M
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- Winch D
- Winstone U
- Winterton D
- Wir WM
- Wise R
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- Wolfer A
- Wollaston J
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- Wong JY
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- Woodgate A
- Woolsey A
- Woon YL
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- Xia J
- Xia Y
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- Xiao W
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- Xie G
- Xie J
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- Xifara A
- Xiong X
- Xiong Y
- Xouplidis K
- Xu G-J
- Xu L
- Xu L
- Xu Q
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- Xue R
- Yagnik A
- Yan Y
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- Yang L
- Yang Q
- Yang S
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- Yang Y
- Yao S
- Yao Y
- Yap HL
- Yarwood J
- Yassaee A
- Ye H
- Ye H
- Yegnaram S
- Yeh E
- Yin N
- Yip CP
- Yong J
- Yu HC
- Yu S
- Yu T
- Yu Y
- Yuan D
- Yuan F
- Yuan J
- Yuan J
- Yuan Y
- Yuliana A
- Zaimi D
- Zakynthinos S
- Zamudio D
- Zangrillo A
- Zapata DDM
- Zbitnew G
- Zeidan L
- Zeng Q
- Zerman L
- Zettergren J
- Zhang B
- Zhang E
- Zhang H
- Zhang H
- Zhang H
- Zhang J
- Zhang K
- Zhang L
- Zhang M
- Zhang M
- Zhang Q
- Zhang R
- Zhang S
- Zhang W
- Zhang X
- Zhang X
- Zhang X
- Zhang X
- Zhang Y
- Zhang Y
- Zhang Y
- Zhang Y
- Zhao B
- Zhao B
- Zhao C
- Zhao J
- Zhao J
- Zhao L
- Zhao L
- Zhao S
- Zhao T
- Zhao W
- Zhao W
- Zhao X
- Zhen J
- Zheng K
- Zheng L
- Zheng T
- Zhong Y
- Zhou C
- Zhou D
- Zhou H
- Zhou H
- Zhou J
- Zhou J
- Zhou J
- Zhou X-J
- Zhu X
- Zhu X
- Zhu Y
- Zhu Z
- Zhuang X
- Zilis G
- Zin NHM
- Zingerle N
- Zingg U
- Zoerner F
- Zonneveldt H
- Zou X
- Zoulamoglou M
- Zsisku L
- Publication venue
- 'Oxford University Press (OUP)'
- Publication date
- 01/01/2017
- Field of study
This was an investigator-initiated study funded by Nestle Health Sciences through an unrestricted research grant and by a National Institute for Health Research (UK) Professorship held by R.P. The study was sponsored by Queen Mary University of London
Prospective observational cohort study on grading the severity of postoperative complications in global surgery research
- Author
- Abayasinghe Chamika
- Abbas Muntadhar
- Abbott T. E. F.
- Abbott Tom
- Abdullah Noor Hairiza
- Abdur-Rahman Lukman
- Abeloos Jacques
- Abernethy Caroline
- Abidin Ucu Nurhadiat
- Abrunhosa Alexandra
- Absar Mohammed
- Adam Suwayba
- Adams George
- Adamson Michael
- Adekola Oyebola
- Adelaja Yemi
- Ademola Adeyinka
- Adenekan Anthony
- Adenike Odewabi
- Adeolu Augustine A
- Adetoye Adedapo
- Adewale Badru
- Adigun Tinuola
- Adolfsson Anne
- Aflori Laura
- Africander Cucu
- Afshari Arash
- Agarwal Vandana
- Agodirin Olayide
- Aguzzoli Crisitiano
- Ahmad Abdurrahman
- Ahmad Norfaizan
- Ahmad T.
- Ahmad Tahania
- Ahmad Yousra
- Ahmed Ahmed
- Ahmed Jamil
- Ahmed Tahania
- Ai Yanqiu
- Aignatoaie Mariana
- Aimoniotou-Georgiou Eleni
- Akanmu Olanrewaju
- Akerman Nik
- Akinwale Mukaila
- Al Amri Khalid
- Al Hussaini Sabah
- Al-Soudaine Yassr
- Aladin Hafiz
- Alagbe-Briggs Olubusola
- Albaj Safauldeensalem
- Alcock David
- Alcock Liam
- Aldecoa Cesar
- Aldecoa Cesar
- Aleixo Fábia Berganton
- Alexander Hazel
- Alexander Maini
- Alexander-Sefre Farhad
- Alherz Fadhel
- Ali Hani
- Ali Marlynn
- Ali Sarah
- Alias Abdul Hafiz
- Alias Anita
- Alias Raja Liza Raja
- Allen Samantha
- Allen Sara Jane
- Allison Joanna
- Alloj Chiara
- Allorto Nikki Leigh
- Allsop Joanne
- Almeida William
- Alonso Eduardo
- Alonso José Ignacio
- Alphonsus Christella
- Alvares Danielle
- Alves Maria Joao
- Amador Juan Carlos Bravo
- Ameer Yusuf
- Amendola Cristina Prata
- Ami Noam
- Amstrup-Hansen Louise
- Anagnou Athina
- Andersen Cheme
- Anderson Charlotte
- Anderson Colette
- Anderson Frank
- Anderson Philip
- Andreadaki Evangelia
- Andreou Alexandros
- Andreou Prematie
- Andrew Alyson
- Andrews Emma
- Angel Miguel Paludi
- Angermair Stefan
- Angus Kirsty
- Anillo Victor
- Anizi Mashel Al
- Antal Oana
- Antill Philip
- Antoniadou Eleni
- Apagaki Eymorfia
- Apostolou Konstantinos
- Applewhaite Christopher
- Applewhaite Christopher
- Aquino Laura Patricia González
- Ar Praburaj
- Araujo Daniela Marques
- Arawwawala Dilshan
- Ardern Diane
- Argue Ruth
- Aribawa Mahaalit Alit
- Arkalaki Eleni
- Armaganidis Apostolos
- Armstrong John
- Armstrong Richard
- Arnaoutoglou Christina
- Arnaoutoglou Elena
- Arnold Glenn
- Arrandale Lindsay
- Arrich James
- Arrigo Mario
- Arshad Homa
- Arshad Mohammed Asif
- Artiles Tania Socorro
- Arumugam Swarna
- Arustei Mirela
- Arvaniti Kostoula
- Arvaniti Kostoula
- Arya Aryabiantara
- Arya Shobhit
- Asimakos Andreas
- Aslam M
- Asudo Felicia
- Athanasakis Elias
- Atiku Mamuda
- Attrill Elizabeth
- Attwood Clare
- Auer Patrick
- Avidan Michael
- Avila Erendira Jocelin Dominguez
- Avis Joanne
- Awad Hadi
- Axioti Elena
- Azam Ummi Azmira Ahmad
- Azambuja Pedro
- Azevedo Caroline
- Aziz Faizal Zuhri
- Baas Peter
- Baghirzada Leyla
- Bai Hui-Ping
- Baillie Shelley
- Baines Duncan
- Baio Thalissa Hermínia
- Bairaktari Aggeliki
- Baker Gerard
- Baker Katie-Anne
- Baker Paul
- Balain Birender
- Balajonda Naraida
- Balanescu Andreea
- Balasubramaniam Madhu
- Baldisserotto Sérgio
- Baldwin Jacqueline
- Baldwin Matthew
- Balfoussia Danai
- Bali Christina
- Bandeira Maria Expedito
- Banerjee Robin
- Bankewitz Carla
- Banner-Goodspeed Valerie
- Bao Qi
- Barcraft-Barnes Helena
- Barneto Lisa
- Barnett Andrew
- Barraclough James
- Barras Jean-Pierre
- Barrett Stephen
- Barrett Wendy Joan
- Basanth Sujith
- Batchelor Nick
- Bateman Brian
- Bates Alexander
- Bates Sarah
- Batista Hugo Dias
- Bauchmuller Kris
- Bauer Marlene
- Baumgarten Georg
- Baxter Linden
- Beaton Ceri
- Beattie Scott
- Beattie Scott
- Beattie Scott
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- Biais M.
- Biais Matthieu
- Biais Matthieu
- Biccard Bruce
- Biccard Bruce M
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- Blackwood Douglas
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- Blakemore Stephen P
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- Buise Marc
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- Bunwarie Bimalshakth
- Burns Karen
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- Butt Georgina
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- Carr Adrienne
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- Castle Gail
- Castro Gabriel Isaac Pereira
- Cavanagh Sarah
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- Chaloulis Panagiotis
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- Chandra Susilo
- Chandrasekharan Shardha
- Chang Yuan Hsuan
- Chaniotaki Fotini
- Charitos Efthimios
- Charlalampidoy Alexandra
- Charles Rob
- Chatterjee Devnandan
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- Chatzimichali Aikaterini
- Chau Simon
- Chazova Elena
- Cheah Clarissa
- Cheah Seleen
- Cheeseman Michelle
- Cheing Yushio
- Chen Chao
- Chen Chen
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- Chen Hong
- Chen James
- Chen Junping
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- Chen Lee-lynn
- Chen Linbi
- Chen Liyong
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- Chen Qiang
- Chen Rong
- Chen Shasha
- Chen Shiyu
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- Chen Yijiao
- Chen Yijun
- Chen Yongjie
- Chen Zhang
- Cheng Baoli
- Cheng Ka Ho
- Cherian Ritchie
- Cherrett Veronica
- Chetty Rubendraj R
- Chew Michelle
- Chew Michelle
- Chhabra Ashok
- Chicken Dennis-Wayne
- Chilinciuc Ion
- Chin Im Im
- Chirkut Subash
- Chlorou Dimitra
- Choi Hyun-min David
- Choi Stephen
- Chow Lorraine
- Christian Rachel
- Christiansen Ida Cecilie
- Christmas Natasha
- Christodoulidis Gregory
- Christodoulopoulou Theodora
- Christofaki Maria
- Christoforidis Dimitri
- Chronis Christos
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- Chu Susanna
- Chua Pandora
- Chukkambotla Srikanth
- Chung Chun Kwong Eric
- Cifra Elna
- Ciobanu Cristina
- Ciobotaru Oana Roxana
- Cirstea Emanuel
- Clark Richard
- Clarkson Aisling
- Clavien Pierre-Alain
- Claxton Andrew
- Clemmons Karen
- Cloro Luigi Maria
- Clyde Antony
- Cobzaru Isabelle
- Codita Anisoara
- Colangelo Antonio
- Colangelo Chiara
- Colling Kerry
- Collins Michelle
- Collins Nwokoro
- Colvin Carolyn
- Commey Thelma
- Comptaer Nicolas
- Conceição Soares Maria
- Conde Carlos
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- Constantin Kathryn
- Cook Tim
- Cooper Lauren
- Cooper Lucy
- Cooper Mariese
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- Cooper Sarah
- Copaciu Elena
- Cope Jennifer
- Copley Edward
- Copotoiu Sanda Maria
- Coppens Marc
- Corneci Dan
- Cornell Jonathan
- Cornish Julie
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- Costa Fischer Bruna Ferreira
- Costa Ana Cristina Miranda Martins
- Costanzo Eleonora
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- Delgado García David R
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- Gambhir Rajiv
- Ganter Donna Louise
- Ganter Michael T
- Gao Hong
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- Garcia Juliana
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- Zbitnew Geoff
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- Zettergren Jan
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- Zhang Xiaoguang
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- Zhang Xiaoyan
- Zhang Yan
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- Zhang Ye
- Zhang Yuan
- Zhao Bing
- Zhao Bo
- Zhao Chong
- Zhao Jiashi
- Zhao Jinning
- Zhao Lei
- Zhao Shuna
- Zhao Ting
- Zhao Weihong
- Zhao Weilu
- Zhao Xiaoying
- Zhen Jungang
- Zheng Kang
- Zheng Lina
- Zheng Tianzhao
- Zhong Yi
- Zhou Ce
- Zhou Dachun
- Zhou Haidong
- Zhou Haiyan
- Zhou Jiali
- Zhou Jialong
- Zhou Jing
- Zhou Xian-jin
- Zhu Xiaomao
- Zhu Yi
- Zhu Zhipeng
- Zhuang Xiuxiu
- Zilis Georgios
- Zin Nor Hafizah Mohd
- Zingerle Nicolette
- Zingg Urs
- Zoerner Frank
- Zonneveldt Harry
- Zou Xiaohua
- Zoulamoglou Menelaos
- Zsisku Lajos
- Zundert Tom
- Zyl Rebekka
- åkring Irene
- Ögren Katrin
- Publication venue
- 'Wiley'
- Publication date
- 22/10/2018
- Field of study
Background
The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs).
Methods
This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs.
Results
A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59).
Conclusion
Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally
The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis
- Author
- Ab Majid Mohd Azuan
- Ab Rahman Ahmad Sufian
- Ab Rahman Rusnah
- Abayasinghe Chamika
- Abbas Muntadhar
- Abbott T. E. F.
- Abbott Tom
- Abd Ghafar Fara Nur Idayu
- Abd Hadi Husni Zaeem
- Abdel Goad Ehab Helmy
- Abdullah Noor Hairiza
- Abdur-Rahman Lukman
- Abeloos Jacques
- Abernethy Caroline
- Abidin Ucu Nurhadiat
- Abrunhosa Alexandra
- Absar Mohammed
- Adam Suwayba
- Adams David
- Adams George
- Adamson Michael
- Adekola Oyebola
- Adelaja Yemi
- Ademola Adeyinka
- Adenekan Anthony
- Adenike Odewabi
- Adeolu Augustine A.
- Adetoye Adedapo
- Adewale Badru
- Adigun Tinuola
- Adolfsson Anne
- Africander Cucu
- Afshari Arash
- Agarwal Vandana
- Agodirin Olayide
- Aguzzoli Crisitiano
- Ahamed khader null
- Ahmad Azam Ummi Azmira
- Ahmad Abdurrahman
- Ahmad Norfaizan
- Ahmad T.
- Ahmad Tahania
- Ahmad Yousra
- Ahmed Ahmed
- Ahmed Jamil
- Ahmed Tahania
- Ai Yanqiu
- Aignatoaie Mariana
- Aimoniotou-Georgiou Eleni
- Akanmu Olanrewaju
- Akerman Nik
- Akinwale Mukaila
- Al Anizi Mashel
- Al hussaini Sabah
- Al'Amri Khalid
- Al-Soudaine Yassr
- Aladin Hafiz
- Alagbe-Briggs Olubusola
- Albaj Safauldeensalem
- Alberto Lisi Zaheer Moolla
- AlbertoVolta Carlo
- Alcock David
- Alcock Liam
- Aldecoa Cesar
- Aleixo Fábia Berganton
- Alexander Hazel
- Alexander Maini
- Alexander-Sefre Farhad
- Alherz Fadhel
- Ali Hani
- Ali Marlynn
- Ali Sarah
- Alias Abdul Hafiz
- Alias Anita
- Alit Mahaalit Aribawa
- Allen Samantha
- Allen Sara Jane
- Allison Joanna
- Alloj Chiara
- Allorto Nikki Leigh
- Allsop Joanne
- Almeida William
- Alonso Eduardo
- Alonso José Ignacio
- Alphonsus Christella
- Alvares Danielle
- Alves Maria Joao
- Amador Juan Carlos Bravo
- Ameer Yusuf
- Amendola Cristina Prata
- Ami Noam
- Amstrup-Hansen Louise
- Anagnou Athina
- Andersen Cheme
- Anderson Charlotte
- Anderson Colette
- Anderson Frank
- Anderson Philip
- Andreadaki Evangelia
- Andreou Alexandros
- Andreou Prematie
- Andrew Alyson
- Andrews Emma
- Angermair Stefan
- Angus Kirsty
- Anillo Victor
- Antal Oana
- Antill Philip
- Antoniadou Eleni
- Antonina Webombesa
- Apagaki Eymorfia
- Apostolou Konstantinos
- Applewhaite Christopher
- Aquino Laura Patricia González
- Ar Praburaj
- Arawwawala Dilshan
- Ardern Diane
- Argue Ruth
- Arkalaki Eleni
- Arlo whitehouse null
- Armaganidis Apostolos
- Armstrong John
- Armstrong Richard
- Arnaoutoglou Christina
- Arnaoutoglou Elena
- Arnold Glenn
- Arrandale Lindsay
- Arrich James
- Arrigo Mario
- Arshad Homa
- Arshad Mohammed Asif
- Artiles Tania Socorro
- Arumugam Swarna
- Arustei Mirela
- Arvaniti Kostoula
- Arya Aryabiantara
- Arya Shobhit
- Asimakos Andreas
- Aslam F Noorbhai M.
- Asudo Felicia
- Athanasakis Elias
- Atiku Mamuda
- Attrill Elizabeth
- Attwood Clare
- Auer Patrick
- Avidan Michael
- Avila Erendira Jocelin Dominguez
- Avis Joanne
- Awad Hadi
- Axioti Elena
- Azambuja Pedro
- Azevedo Caroline
- Aziz Faizal Zuhri
- Baas Peter
- Baghirzada Leyla
- Bai Hui-Ping
- Bai Yun
- Baillie Shelley
- Baines Duncan
- Baio Thalissa Hermínia
- Bairaktari Aggeliki
- Baker Gerard
- Baker Katie-Anne
- Baker Paul
- Balain Birender
- Balaji Packianathaswamy
- Balajonda Naraida
- Balanescu Andreea
- Balasubramaniam Madhu
- Baldisserotto Sérgio
- Baldwin Jacqueline
- Baldwin Matthew
- Balfoussia Danai
- Bali Christina
- Bandeira Maria Expedito
- Banerjee Robin
- Bankewitz Carla
- Banner-Goodspeed Valerie
- Bao Qi
- Barcraft-Barnes Helena
- Barneto Lisa
- Barnett Andrew
- Baroselli Antonio
- Barraclough James
- Barras Jean-Pierre
- Barrett Stephen
- Barrett Wendy Joan
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- Yagnik Anmol
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- Zapata Darcy Danitza Mari
- Zbitnew Geoff
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- Zeng Qiuting
- Zerman Luiza
- Zettergren Jan
- Zhang Baoling
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- Zhang Yuan
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- Zhao Bo
- Zhao Chong
- Zhao Jiashi
- Zhao Jinning
- Zhao Lei
- Zhao Lili
- Zhao Shuna
- Zhao Ting
- Zhao Weihong
- Zhao Weilu
- Zhao Xiaoying
- Zhen Jungang
- Zheng Kang
- Zheng Lina
- Zheng Tianzhao
- Zhong Yi
- Zhou Ce
- Zhou Dachun
- Zhou Haidong
- Zhou Haiyan
- Zhou Jiali
- Zhou Jialong
- Zhou Jing
- Zhou Xian-jin
- Zhu Xiaomao
- Zhu Xiaoping
- Zhu Yi
- Zhu Zhipeng
- Zhuang Xiuxiu
- Zilis Georgios
- Zingerle Nicolette
- Zingg Urs
- Zoerner Frank
- Zonneveldt Harry
- Zou Xiaohua
- Zoulamoglou Menelaos
- Zsisku Lajos
- Åkring Irene
- Ögren Katrin
- Publication venue
- Health Sciences Research Commons
- Publication date
- 30/10/2017
- Field of study
© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine