Key result
Modified IHI trigger tool detects adverse events in ~75% of older surgical inpatients.
Why the study?
The study aimed to identify the number, type, and severity of adverse events and the factors associated with their occurrence in older surgical inpatients within the SURGE-Ahead project.
Does the modified IHI Global Trigger Tool identify adverse events and associated factors in older surgical inpatients?
Observational (n=174)
No
Does the modified IHI Global Trigger Tool identify adverse events and associated factors in older surgical inpatients?
A modified IHI Global Trigger Tool identified a high rate of adverse events in older surgical patients, with age, frailty, and operation time predicting the need for geriatric co-management.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to frequent AEs in older surgical inpatients; leaves open whether frailty-targeted strategies reduce events in prospective trials.
The aim of this study was to identify the number, type and severity of adverse events (AE) and the factors associated with the (non)-occurrence of AE in older surgical inpatients within the SURGE-Ahead project. A retrospective chart review within a larger prospective observational study was conducted in three surgical departments of Ulm University Medical Center (trauma surgery, general surgery, urology). Patients undergoing inpatient elective or emergency surgery aged ≥ 70 years with an Identification of Seniors at Risk (ISAR) score ≥ 2 were included. A modified version of the Institute for Healthcare Improvement (IHI) Global Trigger tool (GTT) adapted to the geriatric cohort was utilized to identify AE during hospitalization and within 30 days after discharge. Binary logistic regression was conducted to identify factors associated with an adverse event-free treatment course. Of 174 included participants, 131 (75.3%) had at least one AE. In total 348 AEs were identified, which can be expressed as 155.9 AE per 1000 patient days or 200.0 AE per 100 admissions. In most cases the AE resulted in temporary harm requiring intervention (58.9%). Intra-/postoperative AE (43.8%) and nosocomial infections (18.9%) occurred most frequently. Younger age, shorter operation time and absence of frailty were significantly associated with an AE-free treatment course (AUC 0.81). A notable number of AE were detected in the study population. The addition of the triggers „new Impairment of cognition/vigilance, fluctuating confusion” and “electrolyte disturbances” enhanced the efficacy of the IHI GTT in the geriatric population. Age, frailty status and operation time might predict the need for geriatric co-management. German clinical trials registry (Deutsches Register für klinische Studien, DRKS00030684), registered on 21st November 2022.
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Wolf et al. (2025) conducted an observational in Older surgical inpatients (n=174). Modified IHI Global Trigger Tool was evaluated on Occurrence of at least one adverse event. The modified IHI Global Trigger Tool detected at least one adverse event in 75.3% of older surgical inpatients, with younger age, shorter operation time, and absence of frailty predicting an AE-free course.
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