Characteristics of Surgical Patients at Risk of Adverse Outcomes After Medical Emergency Team Call: A Single Centre Experience

BACKGROUND: As volume and complexity of surgical procedures increase, there is increased likelihood of perioperative physiological deterioration needing activation of Medical Emergency Team (MET) calls. AIMS: We aimed to estimate rate of MET calls in patients admitted for surgery and identify risk factors for perioperative activation of MET calls in a metropolitan teaching hospital with growing surgical acuity. METHODS: We identified risk factors for MET activation in a retrospective cohort study of a convenience sample of patients admitted under surgical services over a 3-month period and compared perioperative outcomes of patients who experienced MET call activation with those who did not. RESULTS: Thirty-three (7%, 95% CI: 5%-9.9%) patients required perioperative MET call activation. Patients needing MET activation were older (71 years vs. 49 years, p < 0.001), had higher Charlson Comorbidity Index (CCI) (median CCI 3 vs. 1, p < 0.001) and were more likely to be on five or more medications, polypharmacy, pre-operatively (58% vs. 21%, p < 0.001). MET call patients were more likely to require ICU admission (49% vs. 3% respectively, p < 0.001) and had a longer median length of hospital stay (median 10 days vs. 2 days, p < 0.001). CONCLUSIONS: The rate of MET call activation in patients admitted for surgery was 7%. Age, CCI and polypharmacy were significant predictors of need for MET activation (associated with need for escalation of care and poorer hospital outcomes). Since risk factors for MET activation were identifiable from data available at admission, there is potential to identify and intervene early in the perioperative period. Further work will determine whether intervention based on these can improve outcomes.