Predictors of In-Hospital Mortality among Surgical Patients Requiring Rapid Response Team Activation
CCCF ePoster library. Tran A. Nov 9, 2018; 233394; 117
Alexandre Tran
Alexandre Tran
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Introduction: Rapid response teams (RRT) are intended to provide supportive care and mitigate adverse events in acutely deteriorating hospital ward patients. Little is known regarding the outcomes for such encounters among patients admitted to surgical wards.

Objectives: We sought to describe the mortality risk and its associated predictors for surgical patients requiring RRT activation.

Methods: We performed a secondary analysis of a prospectively collected registry within a single hospital system (two campuses) between May 2012 and May 2016. Surgical patients were those admitted to a surgical ward with a surgical diagnosis identified by ICD-10 coding. Independent risk factors including patient age, medical comorbidity, admitting service, reason for RRT activation, code status, number of prior hospitalizations and ICU admissions for in-hospital mortality were analyzed using multivariable logistic regression.

Results: We analyzed 2212 RRT activations on discrete surgical patients. Included patients were most commonly admitted to General Surgery (27.3%), Orthopedics (20.7%), Vascular Surgery (11.4%), Neurosurgery (10.7%) and Thoracics (8.3%). Common reasons for activation included heart rate or rhythm abnormalities (21.4%), respiratory distress (19.3%) and altered level of consciousness (16.5%). Approximately 1 in 4 (22.6%) patients required ICU admission and 1 in 5 (19.3%) died while in hospital. After adjusting for confounders including age, medical comorbidity, reason for RRT activation and code status among others, we identified the following RRT-related predictors of in-hospital mortality: longer RRT call duration per 15 minutes (adjusted OR 1.05, 95% CI 1.01 to 1.10) and increased number of RRT activations (adjusted OR 1.54, 95% CI 1.32 to 1.79). Time elapsed between onset of reason for and initiations of RRT activation as well as RRT response time following activation were not significant predictors. The c-statistic for the model was 0.81.

Conclusion: RRT activation in surgical patients identifies people at high risk (20%) of mortality. Increasing frequency and duration of RRT activation are associated with worsening risk of in-hospital mortality. This work identifies potentially actionable risk factors, highlighting a vulnerable population that may benefit from earlier transfer to a higher level acuity of care. 


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