Major elective cancer surgery in the abdomen is associated with substantial morbidity and mortality risk despite optimized anesthesia and surgical techniques.
This project explores the development of a system for early detection of severe complications after cancer surgery.
Background
Major elective cancer surgery in the abdomen is associated with substantial morbidity and mortality risk despite optimized anesthesia and surgical techniques. Thus, it is estimated that severe morbidity occur in 25-35% after abdominal cancer surgery within the first 30 days. Acute mortality is similarly unacceptable high, evidenced by national data showing 8-9% in-hospital mortality after upper abdominal surgery, and around 4-6% within the first 90 postoperative days. The high morbidity and mortality after abdominal cancer surgery is in discrepancy with the fact that these procedures are performed with a curative or life-prolonging aim.
The observed high complication rate after abdominal cancer surgery may be due to late detection of severe complications and potentially to late treatment when the condition has progressed past the point of no return. Thus, all Danish hospitals currently use the Early Warning Score (EWS) system, where a number of physiological parameters are recorded once every 12 hours.
However, no proven survival benefit of this approach has been shown, and a number of critical events (eg. desaturation) can occur between the fixed 12 hours measurements without being detected. Thus, it has been shown that the 12 hours routine measurements (EWS) only detects 5% of the serious cases of severe hypoxia in the wards, when compared
to continuous measurements.
Project Objectives
A continuous (24/7) system that could detect patterns prior to serious post-surgical events anytime would be superior to the current EWS, as preventive interventions can be initiated before the disease becomes manifest, and not until several hours after the damage is done.
Using spectral analysis of a wide range of continuously measured physiological parameters, we will seek to develop an algorithm for prediction of severe postoperative complications after abdominal cancer surgery and define a set of criteria for intervention against severe postoperative events. Hence, the aim is to achieve continuous patient surveillance with a ’wear and forget’ device, for early intervention to prevent the development of a number of postoperative complications, with reduced morbidity, mortality and health care costs, increasing overall survival after cancer treatment.