Clinical trial NCT05626153: Anesthesia Quality Improvement and Patients With Planned ICU Admission
Official title: Effects of Anesthesia Quality Improvement on Outcomes of Patients With Planned ICU Admission: a Prospective Pre-post Intervention Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Anesthesia
Extubation
Intensive Care Unit
Postoperative Complications
Keywords: Anesthesia management
Early extubation
Intensive care unit admission
Postoperative Complications
Lead sponsor: Peking University First Hospital
Sponsor class: OTHER
First posted: 2022-11-23
Enrollment: 1500
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: SEQUENTIAL
Primary purpose: PREVENTION

Brief summary: Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. The concept of Enhanced Recovery After Surgery recommends early extubation. The investigators suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing complications.

Detailed description: Intensive care unit (ICU) is an important part of perioperative management for high-risk patients but is associated with higher medical costs. Improper ICU admission may produce overtreatment without beneficial effects. Studies found that immediate ICU admission after surgery did not reduce the perioperative mortality. Some authors suggested that the indication of ICU admission should be the occurrence of postoperative complications, which will reasonably reduce the use of medical resources.

In clinical practice, delayed recovery after general anesthesia is a common indication for ICU admission after surgery. Old age, high ASA grade, respiratory complications, long duration surgery, large-volume fluid infusion, and use of vasopressors were main factors associated with delayed recovery. The concept of Enhanced Recovery After Surgery recommends early extubation after surgery. Studies showed that, for patients after organ transplantation, immediate extubation in the operating room can shorten hospital stay and reduce medical costs, without increasing mortality.

The investigators suppose that, for patients with planned ICU admission after elective surgery, implementing anesthesia quality improvement including extubation in the operating room will reduce the rate of ICU admission after surgery without increasing postoperative complications.

Eligibility criteria: Inclusion Criteria:

* Age ≥18 years.
* Scheduled to undergo elective surgery.
* Planned ICU admission after surgery.

Exclusion Criteria:

* Refused to participate in the study.
* ICU admission before surgery.
* Unexpected ICU admission.
* Other conditions that are considered unsuitable for study participation.

Primary outcomes:
measure: Incidence of postoperative complication
timeFrame: Up to 30 days after surgery
Secondary outcomes:
measure: Rate of ICU admission
timeFrame: On the 1 day of surgery
measure: Incidence of postoperative delirium
timeFrame: Up to 5 days after surgery
measure: Rate of delayed neurocognitive recovery
timeFrame: up to 7 days after surgery
measure: Length of stay in hospital after surgery
timeFrame: Up to 30 days after surgery
measure: Medical costs during hospitalization
timeFrame: Up to 30 days after surgery
Other outcomes:
measure: Duration of mechanical ventilation
timeFrame: up to 30 days after surgery
measure: Length of stay in ICU after surgery
timeFrame: Up to 30 days after surgery
measure: Rate of ICU re-admission
timeFrame: Up to 30 days after surgery
measure: All-cause 30-day mortality
timeFrame: Up to 30 days after surgery
Locations:
city: Beijing
country: China
facility: Peking University First Hospital
state: Beijing
Study officials:
affiliation: Peking University First Hospital
name: Dong-Xin Wang, MD, PhD
role: PRINCIPAL_INVESTIGATOR
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