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Introduction: Introducing an intensive care unit (ICU)-based medical emergency team (MET) into our hospital was associated with decreased postoperative in-hospital mortality after major surgery. The purpose of the present study was to assess the effect of the MET and other variables on long-term mortality in this patient population.
Methods: We conducted a prospective, controlled, before-and-after trial in a University-affiliated hospital. Participants included consecutive patients admitted for major surgery (surgery requiring hospital stay > 48 hours) during a four month control phase and a four month MET phase. The intervention involved the introduction of a hospital-wide ICU-based MET service to evaluate and treat ward patients with acutely deranged vital signs. Information on long-term mortality was obtained from the Australian death registry. The main outcome measure was patient mortality at 1500 days. Data on patient demographics, surgery undertaken and whether the surgery was scheduled or unscheduled was obtained from the hospital electronic database. Multivariable analysis was conducted to determine independent predictors of 1500-day mortality.
Results: There were 1,369 major operations in 1,116 patients during the control period and 1,313 operations in 1,067 patients during the MET (intervention) period. Overall survival at 1500 days was 65.8% in the control period and 71.6% during the MET period (P = 0.001). Patients in the control phase were statistically less likely to be admitted under orthopaedic surgery, urology and faciomaxillary surgery units, but more likely to be admitted under cardiac surgery or neurosurgery units. Patients in the MET period were less likely to undergo unscheduled surgery. Multivariable analysis revealed that age, unscheduled surgery and admission under thoracic surgery, neurosurgery, oncology and general medicine were independent predictors of increased 1500-day mortality. Admission during the MET period was also an independent predictor of decreased 1500-day mortality (odds ratio 0.74; P = 0.005).
Conclusion: Introduction of a MET service in a teaching hospital was associated with increased long-term survival even after adjusting for other factors that contribute to long-term surgical mortality.
Serious adverse events (SAEs) are common among patients admitted to hospital. A review of 30,121 medical records in New York State showed that SAEs affected nearly 4% of all admissions, of which 13.6% led to death. Similar findings have been reported in Australia, Canada and the UK, demonstrating that this is a worldwide problem. In a study of patients undergoing major surgery in our hospital, 16.9% suffered SAEs and 7.1% died.
Cardiac arrests and SAEs in hospital patients are typically not sudden or unexpected. Several studies have demonstrated that these events are heralded by derangements of commonly measured vital signs during the preceding 24 hours. Medical emergency teams (METs), an example of a Rapid Response System (RRS), have been introduced into hospitals to identify, review and treat at-risk patients during the early phase of deterioration. The hypothesis underlying this approach is that early intervention in the course of deterioration improves outcome.
In a previous study we demonstrated that introducing a MET service into our hospital was associated with decreased postoperative SAEs, postoperative mortality and mean duration of hospital stay. However, this study only reported on postoperative mortality to the point of hospital discharge. Furthermore, it did not account for possible confounders that might have contributed to the observed outcome differences. The aim of the present study was to assess the effect of introducing a MET service on long-term survival (to 1500 days, or 4.1 years) in a cohort of patients undergoing major surgery at our hospital. In addition, we assessed patient, procedure and system related variables that might also have influenced long-term postoperative survival.
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