title: Peri-operative medical emergency team activation in liver transplantation.
abstract: BACKGROUND
  The medical emergency team (MET) system functions to promptly identify acutely ill patients at-risk for deterioration. Liver transplant (LT) patients are at-risk for serious post-operative complications.
  
  
  OBJECTIVE
  To evaluate the characteristics of MET activations in post-operative LT patients and to compare clinical outcomes with case-matched controls.
  
  
  METHODS
  Retrospective case-control study of all adult patients receiving LT over a 3-year period. Cases were defined as post-operative LT patients who received a MET activation. Controls were defined as LT patients who did not receive a MET activation during the same period, and were matched for age, sex and pre-operative Model for End-Stage Liver Disease (MELD) score.
  
  
  RESULTS
  We found 10.3% (n=18) of LT patients received a total of 26 MET activations (149.4 per 1000 admissions). The mean (SD) age was 54 (9.5) years and 52% were females. There were no differences in baseline characteristics or underlying liver disease between groups, except pre-operative hepatic encephalopathy was more common among cases (55.6% vs 22.2%, p=0.03). Of the MET activations, respiratory distress was the most common 'trigger' (87.7%). In 42.3% (n=11) of the activations, MET criteria had been fulfilled in the 24 h preceding. In these MET activations, patients were characterised as tachypnoeic, hypoxaemic, hypotensive, tachycardic and/or oligo-anuric. MET patients had significantly longer ICU and hospital lengths of stay, along with greater rate of unplanned ICU re-admission (83.3% vs 13.9%, p<0.0001) compared with controls. MET patients also had higher in-hospital and 1-year post-discharge mortality (p=0.10, <0.001, respectively) compared with controls.
  
  
  CONCLUSIONS
  LT patients with post-operative complications prompting MET activation had higher morbidity and mortality compared with controls; however, the MET may have been under-utilised and/or delayed. Further prospective multi-centre investigation is warranted.
authors.affiliation: Division of Critical Care Medicine, University of Alberta Hospital, 3C1.12 Walter C. Mackenzie Centre, 8440-122 Street, Edmonton, Alberta T6G2B7 Canada.
authors.forename: Ambica
authors.initials: A
authors.lastname: Parmar
authors.forename: Glenda
authors.initials: G
authors.lastname: Meeberg
authors.forename: David
authors.initials: D
authors.lastname: Bigam
authors.forename: Heather
authors.initials: H
authors.lastname: Richardson
authors.forename: R T Noel
authors.initials: RT
authors.lastname: Gibney
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
mesh_terms: D000328:Adult; D005260:Female; D057209:Hospital Rapid Response Team / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D059035:Perioperative Period / Q000706:statistics & numerical data*; D012189:Retrospective Studies