title: Effect of the medical emergency team on long-term mortality following major surgery.
abstract: BACKGROUND
  Introducing an intensive care unit (ICU)-based medical emergency team (MET) into our hospital was associated with decreased postoperative in-hospital mortality after major surgery. The purpose of the present study was to assess the effect of the MET and other variables on long-term mortality in this patient population.
  
  
  METHODS
  We conducted a prospective, controlled, before-and-after trial in a University-affiliated hospital. Participants included consecutive patients admitted for major surgery (surgery requiring hospital stay > 48 hours) during a four month control phase and a four month MET phase. The intervention involved the introduction of a hospital-wide ICU-based MET service to evaluate and treat ward patients with acutely deranged vital signs. Information on long-term mortality was obtained from the Australian death registry. The main outcome measure was patient mortality at 1500 days. Data on patient demographics, surgery undertaken and whether the surgery was scheduled or unscheduled was obtained from the hospital electronic database. Multivariable analysis was conducted to determine independent predictors of 1500-day mortality.
  
  
  RESULTS
  There were 1,369 major operations in 1,116 patients during the control period and 1,313 operations in 1,067 patients during the MET (intervention) period. Overall survival at 1500 days was 65.8% in the control period and 71.6% during the MET period (P = 0.001). Patients in the control phase were statistically less likely to be admitted under orthopaedic surgery, urology and faciomaxillary surgery units, but more likely to be admitted under cardiac surgery or neurosurgery units. Patients in the MET period were less likely to undergo unscheduled surgery. Multivariable analysis revealed that age, unscheduled surgery and admission under thoracic surgery, neurosurgery, oncology and general medicine were independent predictors of increased 1500-day mortality. Admission during the MET period was also an independent predictor of decreased 1500-day mortality (odds ratio 0.74; P = 0.005).
  
  
  CONCLUSIONS
  Introduction of a MET service in a teaching hospital was associated with increased long-term survival even after adjusting for other factors that contribute to long-term surgical mortality.
authors.affiliation: Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia. dazajones@hotmail.com
authors.forename: Daryl
authors.initials: D
authors.lastname: Jones
authors.forename: Moritoki
authors.initials: M
authors.lastname: Egi
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
authors.forename: Donna
authors.initials: D
authors.lastname: Goldsmith
mesh_terms: D001315:Australia; D004632:Emergency Medical Services / Q000458:organization & administration*; D004635:Emergency Medicine / Q000458:organization & administration; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000401:mortality*; D016019:Survival Analysis; D000078329:Workforce