Key result
Hypotension-only MET events occur in younger postoperative patients and require ~4-fold larger fluid boluses than other triggers.
Why the study?
Medical emergency teams improve outcomes for deteriorating patients, but comparisons between hypotension and nonhypotension postoperative orthopaedic events were needed to identify patients requiring further perioperative assessment.
What are the differences in characteristics, management, and outcomes between hypotension-only and nonhypotension MET calls in postoperative orthopaedic patients?
Observational (n=263)
No
What are the differences in characteristics, management, and outcomes between hypotension-only and nonhypotension MET calls in postoperative orthopaedic patients?
Hypotension-only MET calls in postoperative orthopaedic patients are associated with younger age, fewer comorbidities, and different management strategies compared to nonhypotension MET calls.
Hypotension-only MET events may need age-specific fluid strategies in orthopaedic patients; leaves open whether trigger-tailored protocols improve outcomes.
Background: Medical emergency teams (MET) are globally recognized strategies to improve outcomes of deteriorating patients. This study aimed to compare characteristics of hypotension and nonhypotension MET calls by characterizing triggers, timings, risk factors, management strategies, and outcomes of postoperative orthopaedic MET calls and provide information in identifying patients who require further perioperative assessment to facilitate better patient care. Methods: A retrospective, single-center review of postoperative orthopaedic MET calls between October 2017 and April 2019 was performed. MET calls were categorized into three groups depending on MET triggers and analyzed by preoperative, intraoperative, and postoperative parameters. Results: Comparing hypotension-only MET events (Group 1) with other triggers (Group 3), Group 1 showed patients who were younger (71.9 yr vs. 75.8 yr, P =0.012), had elective procedures (52.0% vs. 37.1%, P =0.032), and had non-neck of femoral fracture (71.0% vs. 53.0%, P =0.007). They had fewer comorbidities (Charlson Comorbidity Index: 2.7 vs. 3.6, P =0.011), fewer imaging investigations (12.0% vs. 50.8%, P <0.05), larger volume fluid boluses (0.36L vs. 0.09L, P <0.05), and fewer medication changes (27.0% vs. 43.2%, P =0.013) or additions (18.0% vs. 56.8%, P <0.05). Conclusions: Older age, emergency surgery, higher Charlson Comorbidity Index, preoperative delirium or dementia, and non-neck of femoral fracture orthopaedic patients were at higher risk of nonhypotension METs. In postoperative orthopaedic patients, hypotension-only METs were managed with an average crystalloid fluid bolus of 0.36L. Nonhypotension METs were more likely to be discharged to high level care nursing homes (HLCNH) and less likely to have an ICU admission. These findings have clinical implications for better patient identification and resource allocation of hospital systems. Level of Evidence: Level III.
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Kang et al. (2022) conducted an observational in Postoperative orthopaedic patients requiring medical emergency team (MET) calls (n=263). Hypotension-only MET events vs. Nonhypotension MET events was evaluated on Patient characteristics, triggers, management strategies, and outcomes. Hypotension-only MET events in postoperative orthopaedic patients occurred in younger individuals (71.9 vs 75.8 years, P=0.012) and required larger fluid boluses (0.36L vs 0.09L) than other triggers.
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