Preliminary results of the implementation of a Complex Surgical Patient Area as a tool to improve the quality of care.

Abstract

Introduction: Given the increasing complexity of surgical patients, their evaluation within a Complex Surgical Patient Area (APQC) is essential. This study aims to present the functioning of the APQC and analyze its outcomes.

Methods: Between 2022 and 2024, 73 patients were evaluated, with a mean age of 72.8 ± 10 years. Of these, 97.3% were ASA ≥ III, and 41.1% had a Clinical Frailty Score ≥4. The evaluation centered on a multidisciplinary committee responsible for determining the patient's operability and guiding the intrahospital circuit. During postoperative evolution, patient follow-up was carried out by two complementary teams in continuous communication. Failure to Rescue (FTR) was defined as the death of a patient following one or more serious complications.

Results: The main reason for including patients in the CSPA was multimorbidity in 53.4% of cases and a specific pathology in 28.8%. In 31.5% of cases, the intervention was ruled out, with one-year survival below 40%. Among the 35 operated patients, the Comprehensive Complication Index (CCI) was 18.034 ± 21.94, the average hospital stay was 14.34 ± 20.15 days, and the readmission rate was 25.7%. The FTR rate was 12.5%.

Conclusions: Current data suggest a positive impact of the APQC on the evolution of complex patients. A larger patient sample is needed for a detailed analysis of the factors where APQC activities may have the greatest influence.