Original ArticleAcute Risk Change: An Innovative Measure of Operative Adverse Events and Perioperative Team Performance
Section snippets
Study Population
Data were obtained from a large, UK tertiary center between January 2013 and December 2015. Data from 2013 and 2014 were used for calibration. Data from 2015 were used for hypothesis testing. A database of cardiac surgery patients was obtained from the Intensive Care National Audit and Research Centre (ICNARC), a national database comprising demographic and clinical data from all patients admitted to the ICU. Included in the ICNARC is a new national risk for death calculation developed
Patient Population and Data Quality
A flowchart of patient numbers is shown in Fig 1, and demographic characteristics are shown in Table 2. The combined database had 4,842 patients available for analysis, of which 2,913 provided the data to calibrate the risk score and 1,929 operated in 2015 were analyzed for ARC. Of these 1,929 patients, high (greater than +15%) or low (less than –10%) ARC was identified in 50 patients. Seventeen cases showed favorable ARC and 33 adverse ARC. Both EuroSCORE and the ICNARC model were well
Discussion
ARC is measurable using the UK-validated risk scores, EuroSCORE and the ICNARC model, and can be monitored locally and continuously. It correlates strongly with morbidity markers. Large adverse ARC is associated both with a higher frequency of AEs as well as with unmeasured risk. There is variation in ARC among surgeons.
Because ARC can be measured after the first 24 hours in the ICU using readily available data, it could provide a more rapid identifier of changes in AE rates in the
Acknowledgments
The authors acknowledge the Intensive Care National Audit and Research Center and the Papworth Audit team for providing data for this study.
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