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Canadian journal of anaesthesia = Journal canadien d'anesthesie
Feb, 2024;71 (2): 274-291.

Perioperative quality indicators specific to the practice of anesthesia in noncardiac surgery: an umbrella review.

Frederic Nguyen, Gary Liao, Daniel I McIsaac, Manoj M Lalu, Christopher L Pysyk, Gavin M Hamilton
Author Information
  1. Frederic Nguyen: Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. frenguyen@toh.ca. ORCID
  2. Gary Liao: Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
  3. Daniel I McIsaac: Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
  4. Manoj M Lalu: Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
  5. Christopher L Pysyk: Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
  6. Gavin M Hamilton: Department of Anesthesiology and Pain Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada.
PMID: 38182828 DOI: 10.1007/s12630-023-02671-4

Abstract

PURPOSE: Improvement in delivery of perioperative care depends on the ability to measure outcomes that can direct meaningful changes in practice. We sought to identify and provide an overview of perioperative quality indicators specific to the practice of anesthesia in noncardiac surgery.
SOURCE: We conducted an umbrella review (a systematic review of systematic reviews) according to Joanna Briggs Institute methodology. We included systematic reviews examining perioperative indicators in patients���������18 yr of age undergoing noncardiac surgery. Our primary outcome was any quality indicator specific to anesthesia. Indicators were classified by the Donabedian system and perioperative phase of care. The quality of systematic reviews was assessed using AMSTAR 2 criteria. Level of evidence of quality indicators was stratified by the Oxford Centre for Evidence-Based Medicine Classification.
PRINCIPAL FINDINGS: Our search returned 1,475 studies. After removing duplicates and screening of abstracts and full texts, 23 systematic reviews encompassing 3,164 primary studies met our inclusion criteria. There were 330 unique quality indicators. Process indicators were most common (n���=���169), followed by outcome (n���=���114) and structure indicators (n���=���47). Few identified indicators were supported by high-level evidence (45/330, 14%). Level 1 evidence supported indicators of antibiotic prophylaxis (1a), venous thromboembolism prophylaxis (1a), postoperative nausea/vomiting prophylaxis (1b), maintenance of normothermia (1a), and goal-directed fluid therapy (1b).
CONCLUSION: This umbrella review highlights the scarcity of perioperative quality indicators that are supported by high quality evidence. Future development of quality indicators and recommendations for outcome measurement should focus on metrics that are supported by level 1 evidence. Potential targets for evidence-based quality-improvement programs in anesthesia are identified herein.
STUDY REGISTRATION: PROSPERO (CRD42020164691); first registered 28 April 2020.

Keywords

perioperative medicine quality indicators umbrella review

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MeSH Term

Humans
Quality Indicators, Health Care
Perioperative Care
Anesthesia
Surgical Procedures, Operative
Evidence-Based Medicine
Systematic Reviews as Topic
Systematic Review Journal Article
Article has an altmetric score of 2

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