|dc.description.abstract||<p>Background: Postoperative complications are frequent causes of postoperative
mortality. Such complications may also lead to a prolonged period with decreased
functional and cognitive status. Perioperative care is a factor in postoperative
morbidity and mortality. Until now no common international definitions and
classifications of postoperative complications have been established.</p>
<p>The group of surgical patients with the highest risk of postoperative complications
accounts for perhaps 80% of intra-hospital deaths. With the high volume of surgery
performed worldwide, even a slight reduction in complications would result in a lower
number of preventable deaths. There are several theories on how to decrease
postoperative complications and improve patient safety and patient care. Two factors,
checklists and perioperative fluid balance, are investigated in this thesis.</p>
<p>The overall aim of this thesis is twofold:
1. To study perioperative complications and outcome after major surgery
- Paper I aimed at creating standard definitions of outcome measures for use in
pragmatic large perioperative clinical trials.
- Paper II aimed at providing data on perioperative mortality after non-cardiac
surgery across Europe.
2. To contribute in finding ways to reduce complications after major surgery
- Paper III aimed at identifying the prevalence of surgical checklist use and
possible relationship with mortality.
- Paper IV aimed at evaluating the effect of perioperative goal directed fluid
therapy guided by ScvO2 in open colorectal surgery.</p>
<p>Result: Paper I was a literature review to assess the current state of knowledge about
surgical outcome definitions. A standardized list was created for use in perioperative
research and clinical audition. The outcome measures described are organized into
four different categories: Individual adverse events, Composite outcomes, Grading of
complications and Health related quality of life.</p>
<p>Paper II was a 7 day cohort study (European Surgical Outcome Study) conducted in
498 hospitals across 28 European countries. Intra-hospital mortality data was
registered for all adult patients undergoing non-cardiac surgery. The overall intrahospital
mortality throughout Europe was 4%. A variation in mortality after surgery
throughout Europe could be confirmed. This may indicate a discrepancy in standard of
care. Identification and standardisation of key factors in perioperative care would
subsequently improve outcome throughout Europe.</p>
<p>Paper III determined the point prevalence of checklist use in Europe and its
association with in-hospital mortality, using data collected from the European Surgical
Outcome Study. There was a marked variation between checklist use and mortality in
Europe. The use of a surgical checklist was associated with lower mortality. Although
there is no causality demonstrated, checklist use may be an indicator of hospitals
focusing on improved perioperative care and therefore decrease mortality.</p>
<p>Paper IV investigated the use of goal directed fluid therapy in 241 patients
undergoing abdominal surgery and its influence on postoperative morbidity. Patients
were randomized in a control group receiving standard fluid therapy and an
intervention group using central venous oxygen saturation as a surrogate for cardiac
output to guide fluid therapy. Although there was a difference in the amount of fluid
given between the two groups, the complication rate 30 days after surgery was equal.</p>
<p>Conclusion: We proposed standardised outcome measures for use in future trials
investigating postoperative complications. This contributes to a meaningful
comparison of quality of care in future clinical trials and leaves less room for
interpretation of outcome measures. It is not likely that one single intervention in the
perioperative period will markedly affect outcome. Most likely a multifactorial
intervention will be successful in reaching this goal. However, specific research in the
high-risk surgical population is lacking. It can be assumed that this patient group
would have the greatest benefit from an improved perioperative care pathway.
Better data may be available after foundation of national and international
perioperative registers. This may help to establish a greater research community in perioperative outcome research and assist to identify factors in the perioperative care
pathway that improve outcome.</p>||eng
|dc.publisher||The University of Bergen||eng
|dc.relation.haspart||Paper I: Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, Leva B,
Rhodes A, Hoeft A, Walder B, Chew MS, Pearse RM.
Standards for definitions and use of outcome measures for clinical
effectiveness research in perioperative medicine: European
Perioperative Clinical Outcome (EPCO) definitions: A statement from
the ESA-ESICM joint taskforce on perioperative outcome measures.
Eur J Anaesthesiol. 2015 Feb;32(2):88-105. The article is not available in BORA due to publisher restrictions. The published version is available at: <a href="http://dx.doi.org/10.1097/eja.0000000000000118" target="blank">http://dx.doi.org/10.1097/eja.0000000000000118</a>||eng
|dc.relation.haspart||Paper II: Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B,
Vincent JL, Hoeft A, Rhodes A; European Surgical Outcomes Study
(EuSOS) group for the Trials groups of the European Society of Intensive
Care Medicine and the European Society of Anaesthesiology.
Mortality after surgery in Europe: a 7 day cohort study.
Lancet. 2012 Sep 22;380(9847):1059-65. The article is not available in BORA due to publisher restrictions. The published version is available at: <a href="http://dx.doi.org/10.1016/S0140-6736%2812%2961148-9" target="blank">http://dx.doi.org/10.1016/S0140-6736(12)61148-9</a>||eng
|dc.relation.haspart||Paper III: Jammer I, Ahmad T, Aldecoa C, Koulenti D, Goranović T, Grigoras I, Mazul-Sunko
B, Matos R, Moreno R, Sigurdsson GH, Toft P, Walder B, Rhodes A, Pearse RM; for
the European Surgical Outcomes Study (EuSOS) group.
Point prevalence of surgical checklist use in Europe: relationship with hospital
mortality. Br J Anaesth. 2015 May;114(5):801-7. The article is not available in BORA due to publisher restrictions. The published version is available at: <a href="http://dx.doi.org/10.1093/bja/aeu460" target="blank">http://dx.doi.org/10.1093/bja/aeu460</a>||eng
|dc.relation.haspart||Paper IV: Jammer I, Ulvik A, Erichsen C, Lødemel O, Ostgaard G.
Does central venous oxygen saturation-directed fluid therapy affect
postoperative morbidity after colorectal surgery? A randomized
assessor-blinded controlled trial. Anesthesiology. 2010 Nov;113(5):1072-80. The article is not available in BORA due to publisher restrictions. The published version is available at: <a href="http://dx.doi.org/10.1097/aln.0b013e3181f79337" target="blank">http://dx.doi.org/10.1097/aln.0b013e3181f79337</a>||eng
|dc.title||Perioperative interventions and postoperative outcomes||eng
|dc.rights.holder||Copyright the author. All rights reserved||eng
|bora.peerreviewed||Not peer reviewed||eng