title: Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial).
abstract: BACKGROUND
  Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery.
  
  
  METHODS
  This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation (APACHE) II score of at least 10 who were ready to be transferred to the surgical ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30-day mortality.
  
  
  RESULTS
  In total, 286 patients were included in the modified intention-to-treat analysis. The trial was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310).
  
  
  CONCLUSIONS
  Postoperative intermediate care had no statistically significant effect on 30-day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients.
  
  
  BACKGROUND
  NCT01209663 (http://www.clinicaltrials.gov).
authors: Department of Anaesthesiology and Intensive Care Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
authors: M
authors: M
authors: Vester-Andersen
authors: T
authors: T
authors: Waldau
authors: J
authors: J
authors: Wetterslev
authors: M H
authors: MH
authors: Møller
authors: J
authors: J
authors: Rosenberg
authors: L N
authors: LN
authors: Jørgensen
authors: J C
authors: JC
authors: Jakobsen
authors: A M
authors: AM
authors: Møller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark / Q000453:epidemiology; D013505:Digestive System Surgical Procedures; D019468:Disease Management; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends