Routine posTsuRgical Anesthesia visit to improve patient outcome (TRACE) study
In the Netherlands, about 1.4 million patients undergo anesthesia and surgery on a yearly base. Although mortality rates associated with anesthesia and surgery are relatively low in the Netherlands, a substantial amount of patients face complications and delayed recovery in the postoperative phase, with an estimated number of 30% in a medium-to-high risk population. Postsurgical mortality is mainly caused by the lack of a standardized follow-up of patients who develop early signs of postoperative complications, which results in failure to rescue.
Interestingly, while anesthesia and surgery may both lead to complications, the anesthesiologist is currently not involved in postoperative monitoring of surgical patients. The anesthesiologist, who is highly trained in the monitoring and treatment of deteriorations in vital parameters, could however be of added value regarding the early diagnosis of postoperative complications. In the Routine posTsuRgical Anesthesia visit to improve patient outcome (TRACE) study we therefore investigate whether early diagnosis and treatment of deteriorations in the postoperative health status of the surgical patient by anesthesiologists reduces the failure to rescue rate, and thereby leads to lower postoperative mortality. The TRACE intervention comprises of a standardized anesthesia visit on day 1 and 3 following surgery by an anesthesia healthcare professional. We hypothesize that this improvement of postoperative care reduces 30-day mortality by decreasing failure to rescue rates.
The TRACE study is designed according to a stepped-wedge approach and will be performed in 3 university hospitals and 5 peripheral hospitals in the Netherlands. The study aims to enhance patient value over the full cycle of care. The study includes adult patients with a moderate-to-high risk profile undergoing elective surgery (n=5600) with an indication for postoperative hospital stay. The postoperative visit will be standardized based on the Modified Early Warning Score (MEWS) that estimates vital function. In case of diagnosis of early signs of postoperative complications, the anesthesia health care professional will institute a chain of care for the treatment of these complications, and the prevention of failure to rescue.
An economic evaluation from a hospital perspective will determine whether the costs of the postoperative visit relate to the benefits of a reduced length of hospitalization, the costs for diagnosis and treatment of complications and postoperative mortality rates.
Value-based health care
When the TRACE study is successful it will lead to a redefinition of health care processes for the surgical patient. The TRACE study not only supports a new line of thinking regarding the role of the anesthesiologist in the perioperative process, but also creates an opportunity to improve postoperative recovery and reduce the mortality risk for patients undergoing surgery. It is expected that the costs of the postoperative visit outweigh the gain with respect to reduced health care costs due to complications and postoperative mortality.