Randomized Evidence for Reduction of Perioperative Mortality: An Updated Consensus Process

Objective Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to ide...

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Veröffentlicht in:	Journal of cardiothoracic and vascular anesthesia 2017-04, Vol.31 (2), p.719-730
Hauptverfasser:	Landoni, Giovanni, MD, Pisano, Antonio, MD, Lomivorotov, Vladimir, MD, PhD, Alvaro, Gabriele, MD, Hajjar, Ludhmila, MD, Paternoster, Gianluca, MD, Nigro Neto, Caetano, MD, PhD, Latronico, Nicola, MD, Fominskiy, Evgeny, MD, PhD, Pasin, Laura, MD, Finco, Gabriele, MD, Lobreglio, Rosetta, MD, Azzolini, Maria Luisa, MD, Buscaglia, Giuseppe, MD, Castella, Alberto, MD, Comis, Marco, MD, Conte, Adele, MD, Conte, Massimiliano, MD, Corradi, Francesco, MD, Dal Checco, Erika, MD, De Vuono, Giovanni, MD, Ganzaroli, Marco, MD, Garofalo, Eugenio, MD, Gazivoda, Gordana, MD, Lembo, Rosalba, MSc, Marianello, Daniele, MD, Baiardo Redaelli, Martina, MD, Monaco, Fabrizio, MD, Tarzia, Valentina, MD, Mucchetti, Marta, MD, Belletti, Alessandro, MD, Mura, Paolo, MD, Musu, Mario, MD, Pala, Giovanni, MD, Paltenghi, Massimiliano, MD, Pasyuga, Vadim, MD, Piras, Desiderio, MD, Riefolo, Claudio, DS, Roasio, Agostino, MD, Ruggeri, Laura, MD, Santini, Francesco, MD, Székely, Andrea, MD, PhD, Verniero, Luigi, MD, Vezzani, Antonella, MD, Zangrillo, Alberto, MD, Bellomo, Rinaldo, MD
Format:	Artikel
Sprache:	eng
Schlagworte:	anesthesia Anesthesia & Perioperative Care Congresses as Topic Consensus Critical Care Humans intensive care mortality perioperative care Perioperative Care - methods Perioperative Care - mortality Postoperative Complications - mortality Postoperative Complications - prevention & control Randomized Controlled Trials as Topic - methods
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Zusammenfassung:	Objective Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. Design and Setting A web-based international consensus conference. Participants The study comprised 500 clinicians from 61 countries. Interventions A systematic literature search was performed to identify published literature about nonsurgical interventions, supported by randomized evidence, showing a statistically significant impact on mortality. A consensus conference of experts discussed eligible papers. The interventions identified by the conference then were submitted to colleagues worldwide through a web-based survey. Measurements and Main Results The authors identified 11 interventions contributing to increased survival (perioperative hemodynamic optimization, neuraxial anesthesia, noninvasive ventilation, tranexamic acid, selective decontamination of the gastrointestinal tract, insulin for tight glycemic control, preoperative intra-aortic balloon pump, leuko-depleted red blood cells transfusion, levosimendan, volatile agents, and remote ischemic preconditioning) and 2 interventions showing increased mortality (beta-blocker therapy and aprotinin). Interventions then were voted on by participating clinicians. Percentages of agreement among clinicians in different countries differed significantly for 6 interventions, and a variable gap between evidence and clinical practice was noted. Conclusions The authors identified 13 nonsurgical interventions that may decrease or increase perioperative mortality, with variable agreement by clinicians. Such interventions may be optimal candidates for investigation in high-quality trials and discussion in international guidelines to reduce perioperative mortality.
ISSN:	1053-0770 1532-8422
DOI:	10.1053/j.jvca.2016.07.017