Giovanni Landoni1, Antonio Pisano2, Vladimir Lomivorotov3, Gabriele Alvaro4, Ludhmila Hajjar5, Gianluca Paternoster6, Caetano Nigro Neto7, Nicola Latronico8, Evgeny Fominskiy9, Laura Pasin10, Gabriele Finco11, Rosetta Lobreglio12, Maria Luisa Azzolini10, Giuseppe Buscaglia13, Alberto Castella10, Marco Comis14, Adele Conte2, Massimiliano Conte15, Francesco Corradi16, Erika Dal Checco17, Giovanni De Vuono4, Marco Ganzaroli14, Eugenio Garofalo4, Gordana Gazivoda18, Rosalba Lembo10, Daniele Marianello19, Martina Baiardo Redaelli10, Fabrizio Monaco10, Valentina Tarzia10, Marta Mucchetti10, Alessandro Belletti10, Paolo Mura11, Mario Musu12, Giovanni Pala20, Massimiliano Paltenghi8, Vadim Pasyuga21, Desiderio Piras11, Claudio Riefolo10, Agostino Roasio22, Laura Ruggeri10, Francesco Santini23, Andrea Székely24, Luigi Verniero2, Antonella Vezzani25, Alberto Zangrillo26, Rinaldo Bellomo27. 1. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. Electronic address: landoni.giovanni@hsr.it. 2. Division of Cardiac Anaesthesia and Intensive Care, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy. 3. Department of Anaesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia. 4. Department of Anaesthesia and Intensive Care, Azienda Ospedaliera Universitaria "Mater Domini," Catanzaro, Italy. 5. Disciplina de Anestesia, Incor-Hospital das Clinicas, Sao Paulo, Brazil. 6. Department of Cardiovascular Anaesthesia and Intensive Care, Ospedale San Carlo, Potenza, Italy. 7. Dante Pazzanese Institute of Cardiology, Department of Anesthesia and Intensive Care, Sao Paulo, Brazil. 8. Department of Anaesthesia and Intensive Care, Spedali Civili, Brescia, Italy. 9. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Anaesthesia and Intensive Care, Academician EN Meshalkin Novosibirsk State Budget Research Institute of Circulation Pathology, Novosibirsk, Russia. 10. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy. 11. Anesthesia and Intensive Care Unit, Policlinico "Duilio Casula" AOU Cagliari, Department of Medical Sciences "M. Aresu," Cagliari, Italy. 12. Department of Cardiac Anaesthesia and Intensive Care, San Giovanni Battista Hospital, University of Turin, Turin, Italy. 13. Department of Cardiac Anaesthesia and Intensive Care, IRCCS University Hospital San Martino IST, Genova, Italy. 14. Cardiac and Vascular Department, Ospedale Mauriziano Umberto I, Torino, Italy. 15. Department of Anesthesia and Intensive Care, Mater Dei Hospital, Bari, Italy. 16. Department of Anaesthesia and Intensive Care, Ente Ospedaliero Ospedali Galliera, Genova, Italy. 17. Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, Università degli Studi di Bologna-Azienda Ospedaliera Sant'Orsola-Malpighi, Bologna, Italy. 18. Department of Anaesthesia and Intensive Care, Institute of Cardiovascular Diseases Dedinje, Belgrade, Serbia. 19. Department of Thoracic and Cardiac Surgery, University of Siena, Siena, Italy. 20. Department of Cardioanesthesia and Intensive Care, Ospedale Civile Santissima Annunziata, Sassari, Italy. 21. Cardiac Anaesthesia and Intensive Care, Federal Centre for Cardiac Surgery, Astrakhan, Russia. 22. Department of Anaesthesia and Intensive Care, Ospedale Cardinal Massaia di Asti, Asti, Italy. 23. Division of Cardiac Surgery, IRCCS University Hospital San Martino IST, Genova, Italy. 24. Department of Anaesthesiology and Intensive Care, Semmelweis Egyetem, Budapest, Hungary. 25. Dipartimento Cardio-Nefro-Polmonare, Sezione Terapia Intensiva Cardiochirurgica, Azienda Ospedaliero Universitaria di Parma, Parma, Italy. 26. Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy. 27. Intensive Care, Austin Hospital, Melbourne, Australia.
Abstract
OBJECTIVE: Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. DESIGN AND SETTING: A web-based international consensus conference. PARTICIPANTS: The study comprised 500 clinicians from 61 countries. INTERVENTIONS: A systematic literature search was performed to identify published literature about nonsurgical interventions, supported by randomized evidence, showing a statistically significant impact on mortality. A consensus conference of experts discussed eligible papers. The interventions identified by the conference then were submitted to colleagues worldwide through a web-based survey. MEASUREMENTS AND MAIN RESULTS: The authors identified 11 interventions contributing to increased survival (perioperative hemodynamic optimization, neuraxial anesthesia, noninvasive ventilation, tranexamic acid, selective decontamination of the gastrointestinal tract, insulin for tight glycemic control, preoperative intra-aortic balloon pump, leuko-depleted red blood cells transfusion, levosimendan, volatile agents, and remote ischemic preconditioning) and 2 interventions showing increased mortality (beta-blocker therapy and aprotinin). Interventions then were voted on by participating clinicians. Percentages of agreement among clinicians in different countries differed significantly for 6 interventions, and a variable gap between evidence and clinical practice was noted. CONCLUSIONS: The authors identified 13 nonsurgical interventions that may decrease or increase perioperative mortality, with variable agreement by clinicians. Such interventions may be optimal candidates for investigation in high-quality trials and discussion in international guidelines to reduce perioperative mortality.
OBJECTIVE: Of the 230 million patients undergoing major surgical procedures every year, more than 1 million will die within 30 days. Thus, any nonsurgical interventions that help reduce perioperative mortality might save thousands of lives. The authors have updated a previous consensus process to identify all the nonsurgical interventions, supported by randomized evidence, that may help reduce perioperative mortality. DESIGN AND SETTING: A web-based international consensus conference. PARTICIPANTS: The study comprised 500 clinicians from 61 countries. INTERVENTIONS: A systematic literature search was performed to identify published literature about nonsurgical interventions, supported by randomized evidence, showing a statistically significant impact on mortality. A consensus conference of experts discussed eligible papers. The interventions identified by the conference then were submitted to colleagues worldwide through a web-based survey. MEASUREMENTS AND MAIN RESULTS: The authors identified 11 interventions contributing to increased survival (perioperative hemodynamic optimization, neuraxial anesthesia, noninvasive ventilation, tranexamic acid, selective decontamination of the gastrointestinal tract, insulin for tight glycemic control, preoperative intra-aortic balloon pump, leuko-depleted red blood cells transfusion, levosimendan, volatile agents, and remote ischemic preconditioning) and 2 interventions showing increased mortality (beta-blocker therapy and aprotinin). Interventions then were voted on by participating clinicians. Percentages of agreement among clinicians in different countries differed significantly for 6 interventions, and a variable gap between evidence and clinical practice was noted. CONCLUSIONS: The authors identified 13 nonsurgical interventions that may decrease or increase perioperative mortality, with variable agreement by clinicians. Such interventions may be optimal candidates for investigation in high-quality trials and discussion in international guidelines to reduce perioperative mortality.
Authors: Ewa M Kucewicz-Czech; Tomasz Maciejewski; Barbara Budziarz; Tadeusz Kołodziej; Kazimierz Kiermasz; Leszek Machej Journal: Kardiochir Torakochirurgia Pol Date: 2018-03-28
Authors: Sylvain Boet; Cole Etherington; David Nicola; Andrew Beck; Susan Bragg; Ian D Carrigan; Sarah Larrigan; Cassandra T Mendonca; Isaac Miao; Tatyana Postonogova; Benjamin Walker; José De Wit; Karim Mohamed; Nadia Balaa; Manoj Mathew Lalu; Daniel I McIsaac; David Moher; Adrienne Stevens; Donald Miller Journal: Syst Rev Date: 2018-11-30
Authors: Francesco De Simone; Luigi Cassarà; Salvatore Sardo; Elena Scarparo; Omar Saleh; Caetano Nigro Neto; Alberto Zangrillo; Giovanni Landoni Journal: Ann Card Anaesth Date: 2017 Oct-Dec