title: Deviation from a preoperative surgical and anaesthetic care plan is associated with increased risk of adverse intraoperative events in major abdominal surgery.
abstract: BACKGROUND
  Perioperative coordination facilitates team communication and planning. The aim of this study was to determine how often deviation from predicted surgical conditions and a pre-established anaesthetic care plan in major abdominal surgery occurred, and whether this was associated with an increase in adverse clinical events.
  
  
  METHODS
  In this prospective observational study, weekly preoperative interdisciplinary team meetings were conducted according to a joint care plan checklist in a tertiary care centre in France. Any discordance with preoperative predictions and deviation from the care plan were noted. A link to the incidence of predetermined adverse intraoperative events was investigated.
  
  
  RESULTS
  Intraoperative adverse clinical events (ACEs) occurred in 15 % of all cases and were associated with postoperative complications [relative risk (RR) = 1.5; 95 % confidence interval (1.1; 2.2)]. Quality of prediction of surgical procedural items was modest, with one in five to six items not correctly predicted. Discordant surgical prediction was associated with an increased incidence of ACE. Deviation from the anaesthetic care plan occurred in around 13 %, which was more frequent when surgical prediction was inaccurate (RR > 3) and independently associated with ACE (odds ratio 6).
  
  
  CONCLUSIONS
  Surgery was more difficult than expected in up to one out of five cases. In a similar proportion, disagreement between preoperative care plans and observed clinical management was independently associated with an increased risk of adverse clinical events.
authors.affiliation: Department of Anaesthesiology and Critical Care, Hôpital Beaujon, 100 Bld Général Leclerc, Clichy, Paris, France. gausstoto@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Gauss
authors.forename: P
authors.initials: P
authors.lastname: Merckx
authors.forename: C
authors.initials: C
authors.lastname: Brasher
authors.forename: J
authors.initials: J
authors.lastname: Kavafyan
authors.forename: E
authors.initials: E
authors.lastname: Le Bihan
authors.forename: B
authors.initials: B
authors.lastname: Aussilhou
authors.forename: J
authors.initials: J
authors.lastname: Belghiti
authors.forename: J
authors.initials: J
authors.lastname: Mantz
mesh_terms: D000758:Anesthesia / Q000379:methods*; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D006498:Hepatectomy; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010347:Patient Care Planning / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D012306:Risk; D016896:Treatment Outcome