Preoperative optimisation of oxygen delivery significantly reduced hospital mortality compared to routine perioperative care (3% vs 17%, P=0.007).
RCT (n=138)
Double-blind
Randomized into three groups
No
Does preoperative optimisation of oxygen delivery using adrenaline or dopexamine reduce hospital mortality and morbidity in patients undergoing major elective surgery at risk of complications?
Preoperative optimization of oxygen delivery, particularly with dopexamine, significantly reduces hospital mortality and complications in high-risk patients undergoing major elective surgery.
Absolute Event Rate: 3% vs 17%
p-value: p=0.007
OBJECTIVES: To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome. DESIGN: Randomised controlled trial with double blinding between inotrope groups. SETTING: York District Hospital, England. SUBJECTS: 138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions. INTERVENTIONS: Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery. Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care. MAIN OUTCOME MEASURES: Hospital mortality and morbidity. RESULTS: Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P=0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital. CONCLUSION: Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.
Wilson et al. (Sat,) conducted a rct in Major elective surgery at risk of postoperative complications (n=138). Preoperative optimisation of oxygen delivery (invasive haemodynamic monitoring, fluid, and adrenaline or dopexamine) vs. Routine perioperative care was evaluated on Hospital mortality (p=0.007). Preoperative optimisation of oxygen delivery significantly reduced hospital mortality compared to routine perioperative care (3% vs 17%, P=0.007).
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