TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE): a prospective, multicenter, stepped-wedge, cluster-randomized interventional study

Valerie Fun, Dianne de Korte - de Boer, Linda M. Posthuma, Annick Stolze, Carmen Dirksen, Markus W. Hollmann, Wolfgang Buhre, Christa Boer

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Perioperative complications occur in 30-40% of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality.

Methods: TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery.

Discussion: TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals.

Original languageEnglish
Article number586
Number of pages6
JournalTrials
Volume19
DOIs
Publication statusPublished - 26 Oct 2018

Keywords

  • Anesthesiology
  • Postsurgical complications
  • Failure-to-rescue
  • In-hospital mortality
  • Stepped-wedge cluster randomized trial
  • FAILURE-TO-RESCUE
  • INPATIENT SURGERY
  • MORTALITY
  • COMPLICATIONS
  • POPULATION
  • IDENTIFY
  • COST
  • CARE

Cite this

@article{9d2d04228e1c462fa4095dca110b68c2,
title = "TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE): a prospective, multicenter, stepped-wedge, cluster-randomized interventional study",
abstract = "Background: Perioperative complications occur in 30-40{\%} of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality.Methods: TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery.Discussion: TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals.",
keywords = "Anesthesiology, Postsurgical complications, Failure-to-rescue, In-hospital mortality, Stepped-wedge cluster randomized trial, FAILURE-TO-RESCUE, INPATIENT SURGERY, MORTALITY, COMPLICATIONS, POPULATION, IDENTIFY, COST, CARE",
author = "Valerie Fun and {de Korte - de Boer}, Dianne and Posthuma, {Linda M.} and Annick Stolze and Carmen Dirksen and Hollmann, {Markus W.} and Wolfgang Buhre and Christa Boer",
year = "2018",
month = "10",
day = "26",
doi = "10.1186/s13063-018-2952-5",
language = "English",
volume = "19",
journal = "Trials",
issn = "1745-6215",
publisher = "BioMed Central Ltd",

}

TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE) : a prospective, multicenter, stepped-wedge, cluster-randomized interventional study . / Fun, Valerie; de Korte - de Boer, Dianne; Posthuma, Linda M. ; Stolze, Annick; Dirksen, Carmen; Hollmann, Markus W.; Buhre, Wolfgang; Boer, Christa.

In: Trials, Vol. 19, 586, 26.10.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - TRACE (Routine posTsuRgical Anesthesia visit to improve patient outComE)

T2 - a prospective, multicenter, stepped-wedge, cluster-randomized interventional study

AU - Fun, Valerie

AU - de Korte - de Boer, Dianne

AU - Posthuma, Linda M.

AU - Stolze, Annick

AU - Dirksen, Carmen

AU - Hollmann, Markus W.

AU - Buhre, Wolfgang

AU - Boer, Christa

PY - 2018/10/26

Y1 - 2018/10/26

N2 - Background: Perioperative complications occur in 30-40% of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality.Methods: TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery.Discussion: TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals.

AB - Background: Perioperative complications occur in 30-40% of non-cardiac surgical patients and are the leading cause of early postoperative morbidity and mortality. Regular visits by trained health professionals may decrease the incidence of complications and mortality through earlier detection and adequate treatment of complications. Until now, no studies have been performed on the impact of routine postsurgical anesthesia visits on the incidence of postoperative complications and mortality.Methods: TRACE is a prospective, multicenter, stepped-wedge cluster randomized interventional study in academic and peripheral hospitals in the Netherlands. All hospitals start simultaneously with a control phase in which standard care is provided. Sequentially, in a randomized order, hospitals cross over to the intervention phase in which patients at risk are routinely followed up by an anesthesia professional at postoperative days 1 and 3, aiming to detect and prevent or treat postoperative complications. We aim to include 5600 adult patients who are at high risk of developing complications. The primary outcome variable is 30-day postoperative mortality. Secondary outcomes include incidence of postoperative complications and postoperative quality of life up to one year following surgery. Statistical analyses will be performed to compare the control and intervention cohorts with multilevel linear and logistic regression models, adjusted for temporal trends and for clusters (hospitals). The time horizon of the economic (cost-effectiveness) evaluation will be 30 days and one year following surgery.Discussion: TRACE is the first to study the effects of a routine postoperative visit by an anesthesia healthcare professional on mortality and cost-effectiveness of surgical patients. If the intervention proves to be beneficial for the patient and cost-effective, the stepped-wedge design ensures direct implementation in the participating hospitals.

KW - Anesthesiology

KW - Postsurgical complications

KW - Failure-to-rescue

KW - In-hospital mortality

KW - Stepped-wedge cluster randomized trial

KW - FAILURE-TO-RESCUE

KW - INPATIENT SURGERY

KW - MORTALITY

KW - COMPLICATIONS

KW - POPULATION

KW - IDENTIFY

KW - COST

KW - CARE

U2 - 10.1186/s13063-018-2952-5

DO - 10.1186/s13063-018-2952-5

M3 - Article

VL - 19

JO - Trials

JF - Trials

SN - 1745-6215

M1 - 586

ER -