TY - JOUR
T1 - Routine anaesthesia ward-based patient visits in surgery
T2 - 1-year outcomes of the TRACE randomized clinical trial
AU - Smit-Fun, Valérie M.
AU - De Korte-De Boer, Dianne
AU - Damen, Thomas
AU - Stolze, Annick
AU - Posthuma, Linda M.
AU - Hollmann, Markus W.
AU - Buhre, Wolfgang F.F.A.
AU - Boer, C.
AU - van Kuijk, S.
AU - Noordzij, P. G.
AU - Rinia, M.
AU - Hering, J. P.
AU - In't Veld, B.
AU - Scheffer, G. J.
AU - Breel, J. S.
AU - Bouw, T.
AU - van Dijk, F.
AU - Geurts, J.
AU - Glas, W.
AU - van Gorp, R.
AU - Jwair, A.
AU - Koca, F.
AU - Lange, I.
AU - Preckel, B.
AU - van Roy, J. P.
AU - Theunissen, M.
AU - Wensing, A. G.C.L.
AU - Werger, A.
N1 - Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of BJS Foundation Ltd.
PY - 2025/3/1
Y1 - 2025/3/1
N2 - Background: The TRACE (Routine posTsuRgical Anaesthesia visit to improve patient outComE) RCT did not show any perioperative benefit from ward-based visits by anaesthetists after surgery. The aim of this study was to evaluate the impact of this intervention on longer-term outcomes. Methods: Patients were followed up in the TRACE RCT to 1 year in nine hospitals in the Netherlands. Patients undergoing elective non-cardiac surgery, and at risk for adverse postoperative outcome, were included. Patients in the intervention group additionally received routine anaesthesia visits on postoperative days 1 and 3. Clinical outcome measures included 1-year mortality, hospital readmission, and reoperation. Functional recovery (FR) was measured using the patient-reported global surgical recovery (GSR) index, ability to perform activities of daily living (ADL), and functional recovery index (FRI). Quality of life (QoL) was measured using EQ-5D-5L. Results: Some 5473 adult patients were followed up. No differences were found between the control and intervention groups for clinical, FR, and QoL outcome measures. One-year mortality was 5.4% in the control group and 5.8% in the intervention group, readmission was 27% and 26% respectively, and reoperation was 20% and 18% respectively. At 1 year, FR and QoL had recovered to preoperative levels. However, 30% of patients were not able to fully perform ADL and 40%-51% of patients still reported a problem in the EQ-5D-5L dimensions mobility, usual activities, and pain/discomfort. Conclusion: Routine postoperative anaesthesia ward visits of patients did not improve clinical, functional, and QoL outcomes. A substantial proportion of patients still experienced health-related limitations in daily life 1 year after surgery. In conclusion, an early postoperative intervention with postoperative anaesthesia visits in the ward after non-cardiac surgery had no effect on 30-day or 1-year clinical outcome. Remarkably, TRACE shows that compared with data sampled 10 years ago, 1-year mortality has not improved in the Netherlands. At 1 year, functional recovery or QoL showed little improvement compared with baseline. Importantly, a substantial number of patients still reported incomplete recovery and problems that limit QoL, which indicate that there is still room for improvement.
AB - Background: The TRACE (Routine posTsuRgical Anaesthesia visit to improve patient outComE) RCT did not show any perioperative benefit from ward-based visits by anaesthetists after surgery. The aim of this study was to evaluate the impact of this intervention on longer-term outcomes. Methods: Patients were followed up in the TRACE RCT to 1 year in nine hospitals in the Netherlands. Patients undergoing elective non-cardiac surgery, and at risk for adverse postoperative outcome, were included. Patients in the intervention group additionally received routine anaesthesia visits on postoperative days 1 and 3. Clinical outcome measures included 1-year mortality, hospital readmission, and reoperation. Functional recovery (FR) was measured using the patient-reported global surgical recovery (GSR) index, ability to perform activities of daily living (ADL), and functional recovery index (FRI). Quality of life (QoL) was measured using EQ-5D-5L. Results: Some 5473 adult patients were followed up. No differences were found between the control and intervention groups for clinical, FR, and QoL outcome measures. One-year mortality was 5.4% in the control group and 5.8% in the intervention group, readmission was 27% and 26% respectively, and reoperation was 20% and 18% respectively. At 1 year, FR and QoL had recovered to preoperative levels. However, 30% of patients were not able to fully perform ADL and 40%-51% of patients still reported a problem in the EQ-5D-5L dimensions mobility, usual activities, and pain/discomfort. Conclusion: Routine postoperative anaesthesia ward visits of patients did not improve clinical, functional, and QoL outcomes. A substantial proportion of patients still experienced health-related limitations in daily life 1 year after surgery. In conclusion, an early postoperative intervention with postoperative anaesthesia visits in the ward after non-cardiac surgery had no effect on 30-day or 1-year clinical outcome. Remarkably, TRACE shows that compared with data sampled 10 years ago, 1-year mortality has not improved in the Netherlands. At 1 year, functional recovery or QoL showed little improvement compared with baseline. Importantly, a substantial number of patients still reported incomplete recovery and problems that limit QoL, which indicate that there is still room for improvement.
UR - http://www.scopus.com/inward/record.url?scp=105000051481&partnerID=8YFLogxK
U2 - 10.1093/bjs/znaf019
DO - 10.1093/bjs/znaf019
M3 - Article
C2 - 40071336
AN - SCOPUS:105000051481
SN - 0007-1323
VL - 112
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 3
M1 - znaf019
ER -