Presentation on theme: "Advances in Non-Invasive Monitoring Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative."— Presentation transcript:
Advances in Non-Invasive Monitoring Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan
Technology and Patient Safety Michael O’Reilly, M.D., M.S. Chief Medical Officer Masimo Corporation Professor of Anesthesiology and Perioperative Care University of California-Irvine Adjunct Associate Professor University of Michigan
Technology Convergence Monitoring Information Communication
Conflict of Interest Statement Masimo Corporation
The influence of anesthesia care on surgical outcomes
ACS-NSQIP (ACS=American College of Surgeons)
NSQIP Annual Report – FY 2000 Mortality O/E Ratios for All Operations
But No Intraoperative Data! No… Estimated Blood Loss (EBL) BP, HR, SPO 2, Temperature Duration of Surgery Urine Output………Nothing. But they have 30 Day Outcome. Surgery meets Anesthesiology
Lancet 2012; 380: 1059–65 European Surgical Outcomes Study (EuSOS) group for the Trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology
Lancet 2012; 380: 1059–65 Methods: 7 day cohort study Consecutive patients aged ≥16 years Inpatient non-cardiac surgery 498 hospitals 28 European nations Patients followed up to 60 days Primary endpoint in-hospital mortality Secondary outcome LOS and ICU admission
Lancet 2012; 380: 1059–65 Results: patients 1855 (4%) died before hospital discharge 3599 (8%) patients were admitted to critical care median LOS of 1 ・ 2 days (IQR 0 ・ 9–3 ・ 6) 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates between countries (from 1.2% for Iceland to 21.5% for Latvia)
Lancet 2012; 380: 1059–65 Note the Log Scale!
Lancet 2012; 380: 1059–65 Conclusion: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.
From the Michigan Surgical Collaborative for Outcomes Research and Evaluation, the Department of Surgery, University of Michigan, Ann Arbor. n engl j med 361:14; 2009
84,730 patients Inpatient general and vascular surgery Data from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Hospitals ranked according to risk-adjusted overall rate of death Divided into five groups Each overall mortality quintile assessed the incidence of overall and major complications and the rate of death among patients with major complications. METHODS n engl j med 361:14; 2009
CONCLUSION “In addition to efforts aimed at avoiding complications in the first place, reducing mortality associated with inpatient surgery will require greater attention to the timely recognition and management of complications once they occur.” n engl j med 361:14; 2009
Preventing “Failure to Rescue”
Data We have a lot of data! Information But what we really need is information! Decisions So we make the right decisions Actions Leading to the right action.