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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/Book"><div class="meta-content fm-sec"><div class="iconblock whole_rhythm clearfix no_top_margin"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng180er13-lrg.png" alt="Cover of Evidence review for postoperative recovery in specialist areas" /></a><div class="icnblk_cntnt"><h1 id="_NBK561964_"><span itemprop="name">Evidence review for postoperative recovery in specialist areas</span></h1><div class="subtitle">Perioperative care in adults</div><p><b>Evidence review M</b></p><p><i>NICE Guideline, No. 180</i></p><p class="contrib-group"><h4>Authors</h4><span itemprop="author">National Guideline Centre (UK)</span>.</p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2020 Aug</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-3827-8</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div></div></div></div><div class="body-content whole_rhythm" itemprop="text"><div id="niceng180er13.s1"><h2 id="_niceng180er13_s1_">1. Postoperative management and recovery</h2><div id="niceng180er13.s1.1"><h3>1.1. Review question: What is the clinical and cost effectiveness of postoperative recovery in specialist areas, including intensive care, for adults?</h3></div><div id="niceng180er13.s1.2"><h3>1.2. Introduction</h3><p>Decisions about post-operative destinations for patients undergoing surgery usually fall into two categories. Straightforward, clear-cut decisions where the complexity of the patient comorbidities, the magnitude of the surgery, or both, mandate that the patient requires a higher level of post-operative scrutiny and thus requires a specialist area (high dependency or intensive care) rather than a routine ward. Similarly the lack of the same clearly directs the patient to routine care in a ward environment with no requirement for particular or bespoke observation.</p><p>The second category however is much more complex. Patients with varying degrees of complexity undergoing routine procedures, or well patients undergoing complex or major surgeries and any combination of the same form a large population group where decisions about post-operative care requirements become opaque and difficult to define. Clinicians have an obligation not only to clarify how best to manage this group of patients from a care point of view but furthermore must make decisions about appropriateness of resource allocation. Particularly when the resource is limited and comes at a significant financial cost. Specialist areas are both.</p><p>Although the first category of patients allow fairly easy decision making on specialist area allocation, this second larger group suffers from a lack of a uniform standards and there exists no national guidance to support such decisions. Usually subjective, non-uniform decisions are taken about this group of patients which leads to two sequelae. Over-triage of resources occurs with significant financial implications. Or under-triage takes place where patients later need to be moved to specialist areas whilst having potentially suffered avoidable complications.</p><p>It is thus necessary to determine the patient population that will benefit from recovery in specialist areas thereby allowing appropriate triage of patients to correct areas in the hospital and responsible resource allocation during perioperative planning for what is an expensive and limited resource.</p></div><div id="niceng180er13.s1.3"><h3>1.3. PICO table</h3><p>For full details see the review protocol in <a href="#niceng180er13.appa">appendix A</a>.</p></div><div id="niceng180er13.s1.4"><h3>1.4. Clinical evidence</h3><div id="niceng180er13.s1.4.1"><h4>1.4.1. Included studies</h4><p>Four studies were included in the review.<a class="bk_pop" href="#niceng180er13.ref1"><sup>1</sup></a><sup>,</sup>
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<a class="bk_pop" href="#niceng180er13.ref3"><sup>3</sup></a><sup>,</sup>
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<a class="bk_pop" href="#niceng180er13.ref16"><sup>16</sup></a><sup>,</sup>
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<a class="bk_pop" href="#niceng180er13.ref17"><sup>17</sup></a> these are summarised in <a class="figpopup" href="/books/NBK561964/table/niceng180er13.tab2/?report=objectonly" target="object" rid-figpopup="figniceng180er13tab2" rid-ob="figobniceng180er13tab2">Table 2</a> below. Evidence from these studies is summarised in the clinical evidence summary below (<a class="figpopup" href="/books/NBK561964/table/niceng180er13.tab3/?report=objectonly" target="object" rid-figpopup="figniceng180er13tab3" rid-ob="figobniceng180er13tab3">Table 3</a>).</p><p>See also the study selection flow chart in <a href="#niceng180er13.appc">appendix C</a>, study evidence tables in <a href="#niceng180er13.appd">appendix D</a>, forest plots in <a href="#niceng180er13.appe">appendix E</a> and GRADE tables in <a href="#niceng180er13.appf">appendix F</a>.</p></div><div id="niceng180er13.s1.4.2"><h4>1.4.2. Excluded studies</h4><p>See the excluded studies list in <a href="#niceng180er13.appi">appendix I</a>.</p></div><div id="niceng180er13.s1.4.3"><h4>1.4.3. Summary of clinical studies included in the evidence review</h4><p>See <a href="#niceng180er13.appd">appendix D</a> for full evidence tables.</p></div><div id="niceng180er13.s1.4.4"><h4>1.4.4. Quality assessment of clinical studies included in the evidence review</h4><p>See <a href="#niceng180er13.appf">appendix F</a> for full GRADE tables.</p></div></div><div id="niceng180er13.s1.5"><h3>1.5. Economic evidence</h3><div id="niceng180er13.s1.5.1"><h4>1.5.1. Included studies</h4><p>Two health economic studies were identified with the relevant comparison and have been included in this review.<a class="bk_pop" href="#niceng180er13.ref7"><sup>7</sup></a><sup>,</sup>
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<a class="bk_pop" href="#niceng180er13.ref17"><sup>17</sup></a> These are summarised in the health economic evidence profiles below (<a class="figpopup" href="/books/NBK561964/table/niceng180er13.tab11/?report=objectonly" target="object" rid-figpopup="figniceng180er13tab11" rid-ob="figobniceng180er13tab11">Table 11</a> - <a class="figpopup" href="/books/NBK561964/table/niceng180er13.tab12/?report=objectonly" target="object" rid-figpopup="figniceng180er13tab12" rid-ob="figobniceng180er13tab12">Table 12</a>) and the health economic evidence table in <a href="#niceng180er13.apph">appendix H</a>.</p></div><div id="niceng180er13.s1.5.2"><h4>1.5.2. Excluded studies</h4><p>No health economic studies that were relevant to this question were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng180er13.appg">appendix G</a>.</p></div><div id="niceng180er13.s1.5.3"><h4>1.5.3. Summary of studies included in the economic evidence review</h4></div><div id="niceng180er13.s1.5.4"><h4>1.5.4. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p></div></div><div id="niceng180er13.s1.6"><h3>1.6. Evidence statements</h3><div id="niceng180er13.s1.6.1"><h4>1.6.1. Clinical evidence statements</h4><p>No evidence was found for health-related quality of life, hospital readmission, postponed/cancelled surgery, and patient/family/carer experience of care.</p><div id="niceng180er13.s1.6.1.1"><h5>ICU compared to PACU for adults undergoing surgery – high risk; elective</h5><div id="niceng180er13.s1.6.1.1.1"><h5>Mortality</h5><p>One study found no clinically important difference of PACU compared to ICU on mortality (1 study, n=244, low quality evidence).</p></div></div><div id="niceng180er13.s1.6.1.2"><h5>Outcomes not suitable for GRADE analysis</h5><p>One study found a statistically significant benefit with PACU for length of hospital stay compared to ICU (1 study, n=244, high risk of bias).</p><p>One study found no statistically significant difference between PACU and ICU for complications (1 study, n=244, high risk of bias).</p></div><div id="niceng180er13.s1.6.1.3"><h5>ICU compared to surgical ward for adults undergoing surgery – high risk; elective & emergency</h5><div id="niceng180er13.s1.6.1.3.1"><h5>Mortality</h5><p>One study found a clinically important difference in mortality between ICU and surgical ward care. Mortality was significantly higher in people treated in ICU (1 study, n=61, very low quality evidence).</p></div><div id="niceng180er13.s1.6.1.3.2"><h5>Adverse events</h5><p>One study found a clinically important difference in post-operative complications between ICU and surgical ward care. Complication rate was significantly higher in people treated in ICU (1 study, n=61, low quality evidence).</p></div></div><div id="niceng180er13.s1.6.1.4"><h5>Outcomes not suitable for GRADE analysis</h5><p>One study found length of hospital stay was statistically significantly less with surgical ward care compared to ICU (1 study, n=61, very high risk of bias)</p></div><div id="niceng180er13.s1.6.1.5"><h5>ICU compared to surgical ward for adults undergoing surgery – high risk; elective</h5><div id="niceng180er13.s1.6.1.5.1"><h5>Mortality</h5><p>One study found a clinically important difference in mortality between ICU and surgical ward care. Mortality was significantly higher in people treated in ICU (1 study, n=90, very low quality evidence).</p></div><div id="niceng180er13.s1.6.1.5.2"><h5>Adverse events</h5><p>One study found a clinically important difference in post-operative complications between ICU and surgical ward care. Cardiac complication rate was significantly lower in people treated in ICU (1 study, n=90, low quality evidence).</p></div></div><div id="niceng180er13.s1.6.1.6"><h5>Outcomes not suitable for GRADE analysis</h5><p>One study found not statistically significant difference in length of hospital stay was between surgical ward care and ICU (1 study, n=90, high risk of bias)</p></div></div><div id="niceng180er13.s1.6.2"><h4>1.6.2. Health economic evidence statements</h4><ul><li class="half_rhythm"><div>One cost-utility analysis found that ICU was cost effective compared to a general ward (ICER: £8794 per QALY gained in planned surgery; ICER: £7,932 per QALY gained in acute surgery). This analysis was assessed as partially applicable with potentially serious limitations.</div></li><li class="half_rhythm"><div>One cost-consequence analysis found that HDU was cost-saving compared to a general ward (cost saving: £350) and reduced mortality and emergency laparotomy. This analysis was assessed as partially applicable with potentially serious limitations.</div></li></ul></div></div><div id="niceng180er13.s1.7"><h3>1.7. The committee’s discussion of the evidence</h3><p>Please see recommendation 1.5.1 in the guideline.</p><div id="niceng180er13.s1.7.1"><h4>1.7.1. Interpreting the evidence</h4><div id="niceng180er13.s1.7.1.1"><h5>1.7.1.1. The outcomes that matter most</h5><p>The committee agreed that appropriate triage of patients to specialist recovery areas can reduce postoperative morbidity. As such, all-cause mortality, health-related quality of life, adverse events and complications, and unplanned intensive care admission/readmission were considered as the critical outcomes for decision making. The following outcomes were identified as important for postoperative recovery in specialist areas: length of hospital stay, hospital readmission, postponed/cancelled surgery, and patient/family/carer experience of care.</p><p>No evidence was found for health-related quality of life, hospital readmission, postponed/cancelled surgery, and patient/family/carer experience of care.</p></div><div id="niceng180er13.s1.7.1.2"><h5>1.7.1.2. The quality of the evidence</h5><p>All of the evidence included in this review was derived from non-randomised studies. As such, there was an inherent increased risk of bias associated with the evidence presented and a subsequent lower quality grade associated. The committee suggested that the observational nature of the included studies may have allowed for the comparison of disparate populations, with people receiving care in specialist recovery areas likely to have been less well than those seen in general wards.</p><p>The quality of evidence that was suitable for GRADE analysis ranged from very low to low. The majority of the evidence was graded at low quality. This was mostly due to study design and imprecision of results.</p><p>Outcomes which were not suitable for GRADE analysis were considered to be a high and very high risk of bias.</p></div><div id="niceng180er13.s1.7.1.3"><h5>1.7.1.3. Benefits and harms</h5><p>The committee discussed the evidence from three studies on postoperative recovery in specialist areas for high risk patients undergoing elective surgery.</p><p>One study compared recovery in an ICU to recovery in a PACU followed by transfer to a specialty recovery ward. The committee agreed that there was no notable difference in mortality or complications between people treated in ICU or PACU/specialty ward. The committee also noted that the evidence showed that length of stay was statistically longer in patients treated in an ICU, but felt the difference observed was not of clinical significance.</p><p>A second study retrospectively compared high risk patients treated in and ICU to those seen in a surgical recovery ward. The evidence from this study suggested that those treated in an ICU experienced a greater risk of mortality, perioperative complications and increased length of stay. The committee noted that patients not admitted to ICU met fewer of the criteria considered to demonstrate a necessity of ICU care. Patients admitted to ICU also had higher ASA and POSSUM scores prior to surgery, indicating a difference in baseline health between the two comparison groups. The committee felt these differences were significant and contributed towards the differences in the outcomes.</p><p>The final study compared patients treated in an ICU to those receiving care in a surgical recovery ward after surgery. There was evidence of an increased risk of mortality for patients treated in ICU compared to surgical recovery ward after elective surgery. The study also saw those treated in the ICU were at significantly less risk of experiencing cardiac complications. The committee suggested that this reduced risk of cardiac events echoed their experience of care in specialist areas and could strengthen the support for care in specialty areas for people at increased risk of such complications.</p><p>The committee also discussed the evidence from one study on postoperative recovery in specialist areas for low to intermediate risk patients undergoing elective surgery. The evidence from this study showed no significant difference in mortality between patients receiving postoperative care in a HDU or a surgical ward. The study did report that those cared for in the surgical ward were significantly more likely to experience the postoperative complication of anastomotic leak. 16% of those cared for in a surgical ward were subsequently transferred to receive critical care, although the committee highlighted that there was no valid way to compare this result relatively to the HDU group already receiving critical care.</p><p>The committee agreed that on the whole, the observational data was too significantly confounded by baseline differences in population health to direct any decision making on the location of post-operative care. The committee discussed the benefits such as improved quality of life and reduced incidence of adverse events with a more focussed care in specialist recovery areas. The committee based a recommendation based on this consensus agreement.</p></div></div><div id="niceng180er13.s1.7.2"><h4>1.7.2. Cost effectiveness and resource use</h4><p>Two economic evaluations were identified for this question. One study was a cost-utility analysis and one was a cost-consequence analysis.</p><p>One economic evaluation from Norway identified compared individuals admitted to intensive care units with individuals hypothetically rejected from ICU and receiving care in a general ward. The study was a cost-utility analysis and the model was run separately for over 30,000 individuals, based on individuals from the Norwegian Intensive Care Registry. Results were presented for both acute and planned surgery. Intensive care unit costs were higher than the general ward costs but also generated more QALYs. The cost per QALY gained was £7,932 and £8,794 for acute and planned surgery, respectively. This study was assessed as partially applicable with potentially serious limitations. This was because it was unclear what valuation method was used to measure quality of life, costs included in the model for ICU and general ward stay were much higher than NHS costs and therefore less applicable and it was unclear if complications were included in the model.</p><p>One study conducted a cost-consequence analysis based on a single cohort study in the UK. This study followed people undergoing colorectal surgery with a 1–3% risk of 30 day mortality and admitted them to a general ward or high dependency unit. The study showed that the high dependency unit was cost saving and led to lower mortality and complications. This study was rated as partially applicable with potentially serious limitations. Reasons for this rating included: the measure of effect not being in line with the NICE reference as they did not report QALYs, baseline and treatment effects were based on a single study and a small number of people and the source of unit costs were based on the payment by results tariff which does not capture the actual costs incurred by the NHS.</p><p>The committee agreed that the cost-utility analysis presented could not help them make a recommendation with regards to intensive care units as they felt that it demonstrated intensive care was cost-effective for those who needed to be admitted to ICU but did not demonstrate who these patients were. Although the cost-consequence analysis was conducted in the UK, it was based on a small study conducted at a single hospital and did not fully capture costs.</p><p>The committee felt that it was appropriate to admit adults to ICU if they are definitely high risk, but that there was less clarity around adults who are medium risk (ASA grade 2 or 3). In some circumstances, elective patients can be admitted to ICU when it is not necessary which can result in a longer recovery time for the patient and a waste of a scarce and expensive resource. It was agreed that these patients are better off recovering on a general ward as these cases would result in a high cost to the NHS at no additional benefit. From an emergency surgical perspective, there are adults who would benefit from being in ICU but because there are no beds available, they end up on a general ward and their recovery is disadvantaged. The committee discussed that there are limited beds available in ICU and that adults can end up staying in postoperative recovery longer than necessary until there is an available bed. This can have a negative knock-on effect for those waiting to have surgery as their surgery can be cancelled.</p><p>Since 2011/12 the number of people admitted to critical care (HDU and ICU) in the NHS has increased by 22.5% (Hospital admitted patient care activity, 2016–17), however, this is the overall figure for medical and surgical patients. Those that have undergone a surgical or anaesthetic procedure make up 43.2% of critical care unit admissions. The average cost of a day in intensive care for surgery is very high costing £1,384. For those admitted to a high dependency unit the cost is £707 per day. For those remaining on a general ward the estimated average cost is £407 per day. Therefore, there are considerable differences in the costs of each of these recovery areas, emphasising the need to ensure that the correct adults are being sent to intensive care.</p><p>The committee made a recommendation for people who are at a high risk of complications or mortality and agreed that this was current good practice. There may be some hospitals or specialities that are not using specialist recovery areas for these people and therefore this may have a substantial resource impact for the NHS due to the large number of people affected. For people who are undergoing surgery who are not at high risk, the committee agreed that further evidence would be required to guide practice when it is uncertain whether people would benefit from a specialist recovery area and made a research recommendation.</p></div><div id="niceng180er13.s1.7.3"><h4>1.7.3. Other factors the committee took into account</h4><p>The committee recognise that monitoring is continued into the postoperative period.</p><p>The committee agreed that it is challenging to determine the effectiveness of postoperative care in specialist areas given that most people requiring care in specialist areas will be very unwell and it would be unethical to deny these people the care they may need in ICU. The committee agreed any further research would likely need to be conducted with an ill-defined population of patients who do not clearly fulfil the criteria for level two or above care.</p><p>The committee also noted that the decision as to where a person receives postoperative care can be subjective and dependant on other variables such as bed availability in specialist recovery areas. In addition, the committee noted that National Emergency Laparotomy Audit recommends consideration of admission to critical care for all high risk patients with a predicted mortality ≥5%. The committee therefore made a recommendation that people who are at risk of complications or mortality should receive postoperative care in specialist areas. This is consistent with current practice.</p><p>It was felt that there are clear examples of when people are well enough to be treated postoperatively in a general ward and when people are unwell to the extent where postoperative treatment within an ICU is necessary. However, there is a large group of patients where it is not clear whether they will benefit from the input of specialist teams in specialist areas. Given this is an expensive and limited resource it would be helpful if there was evidence to guide decision making for this patient population. Specifically because there is some variation in current practice regarding where people receive care postoperatively. The committee therefore made a research recommendation.</p></div></div></div><div id="niceng180er13.rl.r1"><h2 id="_niceng180er13_rl_r1_">References</h2><dl class="temp-labeled-list"><dt>1.</dt><dd><div class="bk_ref" id="niceng180er13.ref1">Arshad
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H, Ozer
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HG, Thatcher
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A, Old
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M, Ozer
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E, Agarwal
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A
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et al. Intensive care unit versus non-intensive care unit postoperative management of head and neck free flaps: comparative effectiveness and cost comparisons Head and Neck. 2014; 36(4):536–539 [<a href="https://pubmed.ncbi.nlm.nih.gov/23780531" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23780531</span></a>]</div></dd><dt>2.</dt><dd><div class="bk_ref" id="niceng180er13.ref2">Carter
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AJ, Deselms
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J, Ruyle
|
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S, Morrissey-Lucas
|
||
M, Kollar
|
||
S, Cannon
|
||
S
|
||
et al. Postanesthesia care unit visitation decreases family member anxiety. Journal of Perianesthesia Nursing. 2012; 27(1):3–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/22264615" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22264615</span></a>]</div></dd><dt>3.</dt><dd><div class="bk_ref" id="niceng180er13.ref3">Curran
|
||
JE, Grounds
|
||
RM. Ward versus intensive care management of high-risk surgical patients. British Journal of Surgery. 1998; 85(7):956–961 [<a href="https://pubmed.ncbi.nlm.nih.gov/9692572" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9692572</span></a>]</div></dd><dt>4.</dt><dd><div class="bk_ref" id="niceng180er13.ref4">Dalziel
|
||
K. Postoperative management in the recovery room compared to ICU for cardiac surgery patients. Clayton, Victoria. Centre for Clinical Effectiveness, 2001.</div></dd><dt>5.</dt><dd><div class="bk_ref" id="niceng180er13.ref5">de Almeida
|
||
CC, Boone
|
||
MD, Laviv
|
||
Y, Kasper
|
||
BS, Chen
|
||
CC, Kasper
|
||
EM. The utility of routine intensive care admission for patients undergoing intracranial neurosurgical procedures: A systematic review. Neurocritical Care. 2018; 28(1):35–42 [<a href="https://pubmed.ncbi.nlm.nih.gov/28808901" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28808901</span></a>]</div></dd><dt>6.</dt><dd><div class="bk_ref" id="niceng180er13.ref6">Department of Health. NHS reference costs 2017–18. 2017. Available from: <a href="https://improvement.nhs.uk/resources/reference-costs/#rc1718" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://improvement<wbr style="display:inline-block"></wbr>.nhs<wbr style="display:inline-block"></wbr>.uk/resources/reference-costs/#rc1718</a> Last accessed: 02/08/2019</div></dd><dt>7.</dt><dd><div class="bk_ref" id="niceng180er13.ref7">Lindemark
|
||
F, Haaland
|
||
OA, Kvale
|
||
R, Flaatten
|
||
H, Norheim
|
||
OF, Johansson
|
||
KA. Costs and expected gain in lifetime health from intensive care versus general ward care of 30,712 individual patients: a distribution-weighted cost-effectiveness analysis. Critical Care. 2017; 21:220 [<a href="/pmc/articles/PMC5567919/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5567919</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28830479" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28830479</span></a>]</div></dd><dt>8.</dt><dd><div class="bk_ref" id="niceng180er13.ref8">Lone
|
||
NI, Gillies
|
||
MA, Haddow
|
||
C, Dobbie
|
||
R, Rowan
|
||
KM, Wild
|
||
SH
|
||
et al. Five-year mortality and hospital costs associated with surviving intensive care. American Journal of Respiratory and Critical Care Medicine. 2016; 194(2):198–208 [<a href="/pmc/articles/PMC5003217/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5003217</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26815887" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26815887</span></a>]</div></dd><dt>9.</dt><dd><div class="bk_ref" id="niceng180er13.ref9">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual, updated 2018. London. National Institute for Health and Care Excellence, 2014. Available from: <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>.nice.org<wbr style="display:inline-block"></wbr>.uk/process/pmg20/chapter<wbr style="display:inline-block"></wbr>/introduction-and-overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></dd><dt>10.</dt><dd><div class="bk_ref" id="niceng180er13.ref10">NCT. Trial comparing perioperative care for breast cancer patients at a patient hotel vs a general surgical ward [NCT02403973]. 2015. Available from: <a href="http://Https://clinicaltrials.gov/show/nct02403973" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Https:<wbr style="display:inline-block"></wbr>//clinicaltrials<wbr style="display:inline-block"></wbr>.gov/show/nct02403973</a> Last accessed: 21/08/2018</div></dd><dt>11.</dt><dd><div class="bk_ref" id="niceng180er13.ref11">NCT. Use of a non-ICU specialty ward for immediate post-operative management of head and neck free flap [NCT03340038]. 2017. Available from: <a href="http://Https://clinicaltrials.gov/show/nct03340038" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Https:<wbr style="display:inline-block"></wbr>//clinicaltrials<wbr style="display:inline-block"></wbr>.gov/show/nct03340038</a> Last accessed: 21/08/18</div></dd><dt>12.</dt><dd><div class="bk_ref" id="niceng180er13.ref12">NHS Digital. Hospital admitted patient care activity, 2016–17. 2017. Available from: <a href="https://digital.nhs.uk/data-and-information/publications/statistical/hospital-admitted-patient-care-activity/2016-17" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://digital<wbr style="display:inline-block"></wbr>.nhs.uk<wbr style="display:inline-block"></wbr>/data-and-information<wbr style="display:inline-block"></wbr>/publications/statistical<wbr style="display:inline-block"></wbr>/hospital-admitted-patient-care-activity/2016-17</a></div></dd><dt>13.</dt><dd><div class="bk_ref" id="niceng180er13.ref13">Organisation for Economic Co-operation and Development (OECD). Purchasing power parities (PPP). Available from: <a href="http://www.oecd.org/sdd/prices-ppp/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>.oecd.org/sdd/prices-ppp/</a> Last accessed: 17/06/2019</div></dd><dt>14.</dt><dd><div class="bk_ref" id="niceng180er13.ref14">Pedoto
|
||
A, Heerdt
|
||
PM. Postoperative care after pulmonary resection: Postanesthesia care unit versus intensive care unit. Current Opinion in Anaesthesiology. 2009; 22(1):50–55 [<a href="https://pubmed.ncbi.nlm.nih.gov/19295292" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19295292</span></a>]</div></dd><dt>15.</dt><dd><div class="bk_ref" id="niceng180er13.ref15">Shan
|
||
LQ, Skaggs
|
||
DL, Lee
|
||
C, Kissinger
|
||
C, Myung
|
||
KS. Intensive care unit versus hospital floor: a comparative study of postoperative management of patients with adolescent idiopathic scoliosis. Journal of Bone and Joint Surgery American volume. 2013; 95(7):e40 [<a href="https://pubmed.ncbi.nlm.nih.gov/23553303" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23553303</span></a>]</div></dd><dt>16.</dt><dd><div class="bk_ref" id="niceng180er13.ref16">Swart
|
||
M, Carlisle
|
||
JB. Case-controlled study of critical care or surgical ward care after elective open colorectal surgery. British Journal of Surgery. 2012; 99(2):295–9 [<a href="https://pubmed.ncbi.nlm.nih.gov/22101443" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22101443</span></a>]</div></dd><dt>17.</dt><dd><div class="bk_ref" id="niceng180er13.ref17">Swart
|
||
M, Carlisle
|
||
JB, Goddard
|
||
J. Using predicted 30 day mortality to plan postoperative colorectal surgery care: a cohort study. British Journal of Anaesthesia. 2017; 118(1):100–104 [<a href="https://pubmed.ncbi.nlm.nih.gov/28039247" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28039247</span></a>]</div></dd><dt>18.</dt><dd><div class="bk_ref" id="niceng180er13.ref18">Turner
|
||
J. Randomised controlled trial of a high dependency unit in the post-operative care of patients with fractured neck of femur. A cautionary tale. University of York. 2002. Ph.D.</div></dd><dt>19.</dt><dd><div class="bk_ref" id="niceng180er13.ref19">Turner
|
||
J, Gemmell
|
||
LW. Are high dependency units effective and efficient? A systemic review of the evidence. Clinical Intensive Care. 2003; 14(3–4):123–133</div></dd><dt>20.</dt><dd><div class="bk_ref" id="niceng180er13.ref20">Vester-Andersen
|
||
M, Waldau
|
||
T, Wetterslev
|
||
J, Moller
|
||
MH, Rosenberg
|
||
J, Jorgensen
|
||
LN
|
||
et al. Randomized multicentre feasibility trial of intermediate care versus standard ward care after emergency abdominal surgery (InCare trial). British Journal of Surgery. 2015; 102(6):619–29 [<a href="https://pubmed.ncbi.nlm.nih.gov/25789827" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25789827</span></a>]</div></dd><dt>21.</dt><dd><div class="bk_ref" id="niceng180er13.ref21">White
|
||
PF. PACU fast-tracking: an alternative to “bypassing” the PACU for facilitating the recovery process after ambulatory surgery. Journal of Perianesthesia Nursing. 2003; 18(4):247–253 [<a href="https://pubmed.ncbi.nlm.nih.gov/12923752" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12923752</span></a>]</div></dd></dl></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng180er13.appa"><h3>Appendix A. Review protocols</h3><p id="niceng180er13.appa.et1"><a href="/books/NBK561964/bin/niceng180er13-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Table 14. Review protocol: enhanced recovery programmes</a><span class="small"> (PDF, 181K)</span></p><div id="niceng180er13.appa.tab1" class="table"><h3><span class="label">Table 15</span><span class="title">Health economic review protocol</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appa.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appa.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Review question</th><th id="hd_h_niceng180er13.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">All questions – health economic evidence</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Objectives</b>
|
||
</td><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">To identify health economic studies relevant to any of the review questions.</td></tr><tr><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Search criteria</b>
|
||
</td><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Populations, interventions and comparators must be as specified in the clinical review protocol above.</div></li><li class="half_rhythm"><div>Studies must be of a relevant health economic study design (cost–utility analysis, cost-effectiveness analysis, cost–benefit analysis, cost–consequences analysis, comparative cost analysis).</div></li><li class="half_rhythm"><div>Studies must not be a letter, editorial or commentary, or a review of health economic evaluations. (Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.)</div></li><li class="half_rhythm"><div>Unpublished reports will not be considered unless submitted as part of a call for evidence.</div></li><li class="half_rhythm"><div>Studies must be in English.</div></li></ul></td></tr><tr><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Search strategy</b>
|
||
</td><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A health economic study search will be undertaken using population-specific terms and a health economic study filter – see <a href="#niceng180er13.appb">appendix B</a> below.</td></tr><tr><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<b>Review strategy</b>
|
||
</td><td headers="hd_h_niceng180er13.appa.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Studies not meeting any of the search criteria above will be excluded. Studies published before 2003, abstract-only studies and studies from non-OECD countries or the USA will also be excluded.</p><p>Each remaining study will be assessed for applicability and methodological limitations using the NICE economic evaluation checklist which can be found in appendix H of Developing NICE guidelines: the manual (2014).<a class="bk_pop" href="#niceng180er13.ref9"><sup>9</sup></a></p><p><b>Inclusion and exclusion criteria</b>
|
||
<ul><li class="half_rhythm"><div>If a study is rated as both ‘Directly applicable’ and with ‘Minor limitations’ then it will be included in the guideline. A health economic evidence table will be completed and it will be included in the health economic evidence profile.</div></li><li class="half_rhythm"><div>If a study is rated as either ‘Not applicable’ or with ‘Very serious limitations’ then it will usually be excluded from the guideline. If it is excluded then a health economic evidence table will not be completed and it will not be included in the health economic evidence profile.</div></li><li class="half_rhythm"><div>If a study is rated as ‘Partially applicable’, with ‘Potentially serious limitations’ or both then there is discretion over whether it should be included.</div></li></ul></p>
|
||
<p><b>Where there is discretion</b></p><p>The health economist will make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the guideline committee if required. The ultimate aim is to include health economic studies that are helpful for decision-making in the context of the guideline and the current NHS setting. If several studies are considered of sufficiently high applicability and methodological quality that they could all be included, then the health economist, in discussion with the committee if required, may decide to include only the most applicable studies and to selectively exclude the remaining studies. All studies excluded on the basis of applicability or methodological limitations will be listed with explanation in the excluded health economic studies appendix below.</p><p>The health economist will be guided by the following hierarchies.</p><p><i>Setting:</i>
|
||
<ul><li class="half_rhythm"><div>UK NHS (most applicable).</div></li><li class="half_rhythm"><div>OECD countries with predominantly public health insurance systems (for example, France, Germany, Sweden).</div></li><li class="half_rhythm"><div>OECD countries with predominantly private health insurance systems (for example, Switzerland).</div></li><li class="half_rhythm"><div>Studies set in non-OECD countries or in the USA will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
|
||
<p><i>Health economic study type:</i>
|
||
<ul><li class="half_rhythm"><div>Cost–utility analysis (most applicable).</div></li><li class="half_rhythm"><div>Other type of full economic evaluation (cost–benefit analysis, cost-effectiveness analysis, cost–consequences analysis).</div></li><li class="half_rhythm"><div>Comparative cost analysis.</div></li><li class="half_rhythm"><div>Non-comparative cost analyses including cost-of-illness studies will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
|
||
<p><i>Year of analysis:</i>
|
||
<ul><li class="half_rhythm"><div>The more recent the study, the more applicable it will be.</div></li><li class="half_rhythm"><div>Studies published in 2003 or later but that depend on unit costs and resource data entirely or predominantly from before 2003 will be rated as ‘Not applicable’.</div></li><li class="half_rhythm"><div>Studies published before 2003 will be excluded before being assessed for applicability and methodological limitations.</div></li></ul></p>
|
||
<p><i>Quality and relevance of effectiveness data used in the health economic analysis:</i>
|
||
<ul><li class="half_rhythm"><div>The more closely the clinical effectiveness data used in the health economic analysis match with the outcomes of the studies included in the clinical review the more useful the analysis will be for decision-making in the guideline. For example, economic evaluations based on observational studies will be excluded, when the clinical review is only looking for RCTs,</div></li></ul></p></td></tr></tbody></table></div></div></div><div id="niceng180er13.appb"><h3>Appendix B. Literature search strategies</h3><p>The literature searches for this review are detailed below and complied with the methodology outlined in Developing NICE guidelines: the manual 2014, updated 2018.<a class="bk_pop" href="#niceng180er13.ref9"><sup>9</sup></a></p><p><i>For more detailed information, please see the</i>
|
||
<a href="/books/NBK561964/bin/niceng180er13_bm2.pdf">Methodology</a>
|
||
<i>Review</i>.</p><div id="niceng180er13.appb.s1"><h4>B.1. Clinical search literature search strategy</h4><p>Searches were constructed using a PICO framework where population (P) terms were combined with Intervention (I) and in some cases Comparison (C) terms. Outcomes (O) are rarely used in search strategies for interventions as these concepts may not be well described in title, abstract or indexes and therefore difficult to retrieve. Search filters were applied to the search where appropriate.</p><div id="niceng180er13.appb.tab1" class="table"><h3><span class="label">Table 16</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_niceng180er13.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_niceng180er13.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline (OVID)</td><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>[All years]</p>
|
||
<p>1946 – 30 May 2019</p>
|
||
</td><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Randomised controlled trials</p>
|
||
<p>Systematic review studies</p>
|
||
<p>Observational studies</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase (OVID)</td><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>[All years]</p>
|
||
<p>1974 – 30 May 2019</p>
|
||
</td><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Randomised controlled trials</p>
|
||
<p>Systematic review studies</p>
|
||
<p>Observational studies</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The Cochrane Library (Wiley)</td><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>[All years]</p>
|
||
<p>Cochrane Reviews to 2019 Issue 5 of 12</p>
|
||
<p>CENTRAL to 2019 Issue 5 of 12</p>
|
||
<p>DARE, and NHSEED to 2015 Issue 2 of 4</p>
|
||
<p>HTA to 2016 Issue 4 of 4</p>
|
||
</td><td headers="hd_h_niceng180er13.appb.tab1_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div><div id="niceng180er13.appb.tab2" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab2_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">postoperative care/ or exp Postoperative Period/ or exp perioperative nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postoperative* or postop* or post-op* or post-surg* or postsurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care* or caring or treat* or nurs* or recover* or monitor*) adj3 after adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 4 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/ or exp infant/) not (exp adolescent/ or exp adult/ or exp middle age/ or exp aged/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 not 6</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/8-15</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16 not 17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/18-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 not 25</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intensive care units/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Coronary care units/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recovery room/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Respiratory care units/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intensive or depend*) adj3 (care or caring or unit*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ICU* or SICU* or MICU* or ITU* or CCU* or CICU* or CVICU* or PACU*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care or caring or coronary or respiratory) adj3 unit*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(outreach or out reach).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(recover* adj2 (ward* or room*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(surg* adj2 ward*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(anesthesia or anaesthesia or postanesthesia or postanaesthesia).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 and 38</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">controlled clinical trial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomi#ed.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">placebo.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomly.ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">clinical trials as topic.sh.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">trial.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40-46</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj2 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/48-57</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epidemiologic studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cohort studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Controlled Before-After Studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Historically Controlled Study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interrupted Time Series Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/59-68</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/70-71</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69 or 72</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/74-75</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">77.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69 or 76</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">78.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69 or 72 or 76</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39 and (47 or 58 or 78)</td></tr></tbody></table></div></div><div id="niceng180er13.appb.tab3" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab3_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*postoperative care/ or *postoperative period/ or *perioperative nursing/ or *surgical patient/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postoperative* or postop* or post-op* or post-surg* or postsurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care* or caring or treat* or nurs* or recover* or monitor*) adj3 after adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/1-3</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 4 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/) not (exp adult/ or exp adolescent/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 not 6</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/8-12</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13 not 14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/15-22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 not 23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*intensive care unit/ or exp coronary care unit/ or *medical intensive care unit/ or *neurological intensive care unit/ or *surgical intensive care unit/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intensive or depend*) adj3 (care or caring or unit*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ICU* or SICU* or MICU* or ITU* or CCU* or CICU* or CVICU*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care or caring or coronary or respiratory) adj3 unit*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(outreach or out reach).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(recover* adj2 (ward* or room*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(surg* adj2 ward*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(anesthesia or anaesthesia or postanesthesia or postanaesthesia).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/25-32</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24 and 33</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">factorial*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(crossover* or cross over*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((doubl* or singl*) adj blind*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(assign* or allocat* or volunteer* or placebo*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">crossover procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">single blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">double blind procedure/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/35-43</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">systematic review/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Meta-Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(meta analy* or metanaly* or metaanaly* or meta regression).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((systematic* or evidence*) adj2 (review* or overview*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(reference list* or bibliograph* or hand search* or manual search* or relevant journals).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search strategy or search criteria or systematic search or study selection or data extraction).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(search* adj4 literature).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(medline or pubmed or cochrane or embase or psychlit or psyclit or psychinfo or psycinfo or cinahl or science citation index or bids or cancerlit).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cochrane.jw.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((multiple treatment* or indirect or mixed) adj2 comparison*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/45-54</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Epidemiologic studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Observational study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Cohort studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cohort adj (study or studies or analys* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">60.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((follow up or observational or uncontrolled or non randomi#ed or epidemiologic*) adj (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">61.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((longitudinal or retrospective or prospective or cross sectional) and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">62.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Controlled Before-After Studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">63.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Historically Controlled Study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">64.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Interrupted Time Series Analysis/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">65.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(before adj2 after adj2 (study or studies or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/56-65</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">67.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp case control study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">68.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case control*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">69.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/67-68</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">70.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66 or 69</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">71.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cross-sectional studies/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">72.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cross sectional and (study or studies or review or analys* or cohort* or data)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">73.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/71-72</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">74.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66 or 73</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">75.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">66 or 69 or 73</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">76.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34 and (44 or 55 or 75)</td></tr></tbody></table></div></div><div id="niceng180er13.appb.tab4" class="table"><h3><span class="title">Cochrane Library (Wiley) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab4_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Postoperative Care] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Postoperative Period] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Perioperative Nursing] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #1-#3)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postoperative* or postop* or post-op* or post-surg* or postsurg*) near/3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care* or caring or treat* or nurs* or recover* or monitor*) near/3 (after) near/3 (surg* or operat* or anaesthes* or anesthes*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #4-#6)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Intensive Care Units] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Coronary Care Units] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Recovery Room] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH descriptor: [Respiratory Care Units] this term only</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intensive or depend*) near/3 (care or caring or unit*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(ICU* or SICU* or MICU* or ITU* or CCU* or CICU* or CVICU* or PACU*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care or caring or coronary or respiratory) near/3 unit*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(outreach or out reach):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(recover* near/2 (ward* or room* or unit*)):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(surg* near/2 ward*):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(anesthesia or anaesthesia or postanesthesia or postanaesthesia):ti,ab</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(or #8-#18)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7 and #19</td></tr></tbody></table></div></div></div><div id="niceng180er13.appb.s2"><h4>B.2. Health Economics literature search strategy</h4><p>Health economic evidence was identified by conducting a broad search relating to the perioperative care population in NHS Economic Evaluation Database (NHS EED – this ceased to be updated after March 2015) and the Health Technology Assessment database (HTA) with no date restrictions. NHS EED and HTA databases are hosted by the Centre for Research and Dissemination (CRD). Additional health economics searches were run on Medline and Embase.</p><div id="niceng180er13.appb.tab5" class="table"><h3><span class="label">Table 17</span><span class="title">Database date parameters and filters used</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab5_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Database</th><th id="hd_h_niceng180er13.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Dates searched</th><th id="hd_h_niceng180er13.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Search filter used</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Medline</td><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 30 May 2019</td><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Health economics studies</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Embase</td><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2014 – 30 May 2019</td><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Exclusions</p>
|
||
<p>Health economics studies</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Centre for Research and Dissemination (CRD)</td><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>HTA - Inception – 02 May 2019</p>
|
||
<p>NHSEED - Inception to 02 May 2019</p>
|
||
</td><td headers="hd_h_niceng180er13.appb.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td></tr></tbody></table></div></div><div id="niceng180er13.appb.tab6" class="table"><h3><span class="title">Medline (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab6_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Preoperative Care/ or exp Perioperative Care/ or exp Perioperative Period/ or exp Perioperative Nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((pre-operative* or preoperative* or preop* or pre-op* or pre-surg* or presurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((perioperative* or peri-operative* or intraoperative* or intra-operative* or intrasurg* or intra-surg* or peroperat* or per-operat*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postoperative* or postop* or post-op* or post-surg* or postsurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care* or caring or treat* or nurs* or recover* or monitor*) adj3 (before or prior or advance or during or after) adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 or 2 or 3 or 4 or 5</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(intraoperative* or intra-operative* or intrasurg* or intra-surg* or peroperat* or per-operat* or perioperat* or peri-operat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or duration) adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 or 8</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">postoperative care/ or exp Postoperative Period/ or exp Perioperative nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(postop* or post-op* or post-surg* or postsurg* or perioperat* or peri-operat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(after adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(post adj3 (operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 or 11 or 12 or 13</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Preoperative Care/ or Preoperative Period/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(pre-operat* or preoperat* or pre-surg* or presurg*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((before or prior or advance or pre or prepar*) adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 or 16 or 17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 or 9 or 14 or 18</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">news/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp historical article/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Anecdotes as Topic/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">comment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-27</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28 not 29</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animals/ not humans/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animals, Laboratory/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experimentation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Models, Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodentia/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/30-36</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 not 37</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 38 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/ or exp infant/) not (exp adolescent/ or exp adult/ or exp middle age/ or exp aged/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39 not 40</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">value of life/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “costs and cost analysis”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, Hospital/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Economics, medical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economics, nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">economics, pharmaceutical/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp “Fees and Charges”/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp budgets/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">55.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effectiv* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">56.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">57.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">58.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/42-57</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">59.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41 and 58</td></tr></tbody></table></div></div><div id="niceng180er13.appb.tab7" class="table"><h3><span class="title">Embase (Ovid) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab7_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">*preoperative period/ or *intraoperative period/ or *postoperative period/ or *perioperative nursing/ or *surgical patient/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((pre-operative* or preoperative* or preop* or pre-op* or pre-surg* or presurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((perioperative* or peri-operative* or intraoperative* or intra-operative* or intrasurg* or intra-surg* or peroperat* or per-operat*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((care* or caring or treat* or nurs* or recover* or monitor*) adj3 (before or prior or advance or during or after) adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1 or 2 or 3 or 4</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">peroperative care/ or exp peroperative care/ or exp perioperative nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(intraoperative* or intra-operative* or intrasurg* or intra-surg* or peroperat* or per-operat* or perioperat* or peri-operat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((during or duration) adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">6 or 7 or 8</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">postoperative care/ or exp postoperative period/ or perioperative nursing/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(postop* or post-op* or post-surg* or postsurg* or perioperat* or peri-operat*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(after adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(post adj3 (operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">10 or 11 or 12 or 13</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp preoperative care/ or preoperative period/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(pre-operat* or preoperat* or pre-surg* or presurg*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((before or prior or advance or pre or prepar*) adj3 (surg* or operat* or anaesthes* or anesthes*)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">15 or 16 or 17</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">5 or 9 or 14 or 18</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">letter.pt. or letter/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">note.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">editorial.pt.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">case report/ or case study/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(letter or comment*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/20-24</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">randomized controlled trial/ or random*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">27.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">25 not 26</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">28.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal/ not human/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">29.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">nonhuman/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">30.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Animal Experiment/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">31.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Experimental Animal/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">32.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">animal model/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">33.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp Rodent/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">34.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(rat or rats or mouse or mice).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">35.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/27-34</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">36.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">19 not 35</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">limit 36 to English language</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">38.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(exp child/ or exp pediatrics/) not (exp adult/ or exp adolescent/)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">37 not 38</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">40.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">health economics/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">41.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp economic evaluation/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">42.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp health care cost/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">43.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">exp fee/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">44.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">45.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">funding/</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">46.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">budget*.ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">47.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">cost*.ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">48.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(economic* or pharmaco?economic*).ti.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">49.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(price* or pricing*).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">50.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(cost* adj2 (effectiv* or utilit* or benefit* or minimi* or unit* or estimat* or variable*)).ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">51.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(financ* or fee or fees).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">52.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(value adj2 (money or monetary)).ti,ab.</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">53.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">or/40-52</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">54.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">39 and 53</td></tr></tbody></table></div></div><div id="niceng180er13.appb.tab8" class="table"><h3><span class="title">NHS EED and HTA (CRD) search terms</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appb.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appb.tab8_lrgtbl__"><table><tbody><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Preoperative Care EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#2.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Perioperative Care EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#3.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Perioperative Period EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#4.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Perioperative Nursing EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#5.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((perioperative* or peri-operative* or intraoperative* or intra-operative* or intrasurg* or intra-surg* or peroperat* or per-operat*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#6.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((care* or caring or treat* or nurs* or recover* or monitor*) adj3 (before or prior or advance or during or after) adj3 (surg* or operat* or anaesthes* or anesthes*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#7.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((pre-operative* or preoperative* or preop* or pre-op* or pre-surg* or presurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#8.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((postoperative* or postop* or post-op* or post-surg* or postsurg*) adj3 (care* or caring or treat* or nurs* or monitor* or recover* or medicine)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #5 OR #6 OR #7 OR #8</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(* IN HTA)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(* IN NHSEED)</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9 AND #10</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#13.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#9 AND #11</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#14.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MeSH DESCRIPTOR Intraoperative Care EXPLODE ALL TREES</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#1 OR #2 OR #3 OR #4 OR #14</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#16.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((intraoperative* or intra-operative* or intrasurg* or intra-surg* or peroperat* or per-operat* or perioperat* or peri-operat*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#17.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((during or duration) adj3 (surg* or operat* or anaesthes* or anesthes*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#18.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((postop* or post-op* or post-surg* or postsurg* or perioperat* or peri-operat*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#19.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((after adj3 (surg* or operat* or anaesthes* or anesthes*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#20.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((post adj3 (operat* or anaesthes* or anesthes*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#21.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">((pre-operat* or preoperat* or pre-surg* or presurg*))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#22.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">(((before or prior or advance or pre or prepar*) adj3 (surg* or operat* or anaesthes* or anesthes*)))</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#23.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#24.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#10 AND #23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#25.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#11 AND #23</td></tr><tr><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#26.</td><td rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">#12 OR #13 OR #24 OR #25</td></tr></tbody></table></div></div></div></div><div id="niceng180er13.appc"><h3>Appendix C. Clinical evidence selection</h3><div id="niceng180er13.appc.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%201.%20Flow%20chart%20of%20clinical%20study%20selection%20for%20the%20review%20of%20postoperative%20recovery%20in%20specialist%20areas.&p=BOOKS&id=561964_niceng180er13appcf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appcf1.jpg" alt="Figure 1. Flow chart of clinical study selection for the review of postoperative recovery in specialist areas." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 1</span><span class="title">Flow chart of clinical study selection for the review of postoperative recovery in specialist areas</span></h3></div></div><div id="niceng180er13.appd"><h3>Appendix D. Clinical evidence tables</h3><p id="niceng180er13.appd.et1"><a href="/books/NBK561964/bin/niceng180er13-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (157K)</span></p></div><div id="niceng180er13.appe"><h3>Appendix E. Forest plots</h3><div id="niceng180er13.appe.s1"><h4>E.1. ICU compared to PACU – high risk; elective surgery</h4><div id="niceng180er13.appe.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%202.%20Mortality.&p=BOOKS&id=561964_niceng180er13appef1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef1.jpg" alt="Figure 2. Mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 2</span><span class="title">Mortality</span></h3></div></div><div id="niceng180er13.appe.s2"><h4>E.2. ICU compared to surgical ward – high risk; elective & emergency</h4><div id="niceng180er13.appe.fig2" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%203.%20Mortality.&p=BOOKS&id=561964_niceng180er13appef2.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef2.jpg" alt="Figure 3. Mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 3</span><span class="title">Mortality</span></h3></div><div id="niceng180er13.appe.fig3" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.%20Post-operative%20complications.&p=BOOKS&id=561964_niceng180er13appef3.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef3.jpg" alt="Figure 4. Post-operative complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 4</span><span class="title">Post-operative complications</span></h3></div></div><div id="niceng180er13.appe.s3"><h4>E.3. ICU compared to surgical ward – high risk; elective</h4><div id="niceng180er13.appe.fig4" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%205.%20Mortality.&p=BOOKS&id=561964_niceng180er13appef4.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef4.jpg" alt="Figure 5. Mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 5</span><span class="title">Mortality</span></h3></div><div id="niceng180er13.appe.fig5" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%206.%20Post-operative%20complications.&p=BOOKS&id=561964_niceng180er13appef5.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef5.jpg" alt="Figure 6. Post-operative complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 6</span><span class="title">Post-operative complications</span></h3></div></div><div id="niceng180er13.appe.s4"><h4>E.4. HDU compared to surgical ward – low/intermediate risk; elective</h4><div id="niceng180er13.appe.fig6" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%207.%20Mortality.&p=BOOKS&id=561964_niceng180er13appef6.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef6.jpg" alt="Figure 7. Mortality." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 7</span><span class="title">Mortality</span></h3></div><div id="niceng180er13.appe.fig7" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%208.%20Post-operative%20complications.&p=BOOKS&id=561964_niceng180er13appef7.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appef7.jpg" alt="Figure 8. Post-operative complications." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 8</span><span class="title">Post-operative complications</span></h3></div></div></div><div id="niceng180er13.appf"><h3>Appendix F. GRADE tables</h3><div id="niceng180er13.appf.tab1" class="table"><h3><span class="label">Table 18</span><span class="title">Clinical evidence profile: ICU compared to PACU for adults undergoing surgery – high risk; elective</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appf.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appf.tab1_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.appf.tab1_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng180er13.appf.tab1_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng180er13.appf.tab1_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng180er13.appf.tab1_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab1_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng180er13.appf.tab1_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab1_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1" id="hd_h_niceng180er13.appf.tab1_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_2" id="hd_h_niceng180er13.appf.tab1_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">ICU compared to PACU</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_2" id="hd_h_niceng180er13.appf.tab1_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_3" id="hd_h_niceng180er13.appf.tab1_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_3" id="hd_h_niceng180er13.appf.tab1_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_1 hd_h_niceng180er13.appf.tab1_1_1_2_2 hd_h_niceng180er13.appf.tab1_1_1_2_3 hd_h_niceng180er13.appf.tab1_1_1_2_4 hd_h_niceng180er13.appf.tab1_1_1_2_5 hd_h_niceng180er13.appf.tab1_1_1_2_6 hd_h_niceng180er13.appf.tab1_1_1_2_7 hd_h_niceng180er13.appf.tab1_1_1_1_2 hd_h_niceng180er13.appf.tab1_1_1_2_8 hd_h_niceng180er13.appf.tab1_1_1_2_9 hd_h_niceng180er13.appf.tab1_1_1_1_3 hd_h_niceng180er13.appf.tab1_1_1_2_10 hd_h_niceng180er13.appf.tab1_1_1_2_11 hd_h_niceng180er13.appf.tab1_1_1_1_4 hd_h_niceng180er13.appf.tab1_1_1_1_5" id="hd_b_niceng180er13.appf.tab1_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality</th></tr><tr><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_1 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_2 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies<sup><a class="bk_pop" href="#niceng180er13.appf.tab1_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_3 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab1_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_4 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_5 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_6 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_1 hd_h_niceng180er13.appf.tab1_1_1_2_7 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_2 hd_h_niceng180er13.appf.tab1_1_1_2_8 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>0/119</p>
|
||
<p>(0%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_2 hd_h_niceng180er13.appf.tab1_1_1_2_9 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">0%</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_3 hd_h_niceng180er13.appf.tab1_1_1_2_10 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_3 hd_h_niceng180er13.appf.tab1_1_1_2_11 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">-</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_4 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁⨁◯◯</p>
|
||
<p>LOW</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab1_1_1_1_5 hd_b_niceng180er13.appf.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng180er13.appf.tab1_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design</p></div></dd></dl></div></div></div><div id="niceng180er13.appf.tab2" class="table"><h3><span class="label">Table 19</span><span class="title">Clinical evidence profile: ICU compared to surgical ward for adults undergoing surgery – high risk; elective & emergency</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appf.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appf.tab2_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.appf.tab2_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng180er13.appf.tab2_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng180er13.appf.tab2_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng180er13.appf.tab2_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab2_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng180er13.appf.tab2_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab2_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1" id="hd_h_niceng180er13.appf.tab2_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_2" id="hd_h_niceng180er13.appf.tab2_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">ICU compared to surgical ward</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_2" id="hd_h_niceng180er13.appf.tab2_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_3" id="hd_h_niceng180er13.appf.tab2_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_3" id="hd_h_niceng180er13.appf.tab2_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_1 hd_h_niceng180er13.appf.tab2_1_1_2_2 hd_h_niceng180er13.appf.tab2_1_1_2_3 hd_h_niceng180er13.appf.tab2_1_1_2_4 hd_h_niceng180er13.appf.tab2_1_1_2_5 hd_h_niceng180er13.appf.tab2_1_1_2_6 hd_h_niceng180er13.appf.tab2_1_1_2_7 hd_h_niceng180er13.appf.tab2_1_1_1_2 hd_h_niceng180er13.appf.tab2_1_1_2_8 hd_h_niceng180er13.appf.tab2_1_1_2_9 hd_h_niceng180er13.appf.tab2_1_1_1_3 hd_h_niceng180er13.appf.tab2_1_1_2_10 hd_h_niceng180er13.appf.tab2_1_1_2_11 hd_h_niceng180er13.appf.tab2_1_1_1_4 hd_h_niceng180er13.appf.tab2_1_1_1_5" id="hd_b_niceng180er13.appf.tab2_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality</th></tr><tr><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_1 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_2 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies<sup><a class="bk_pop" href="#niceng180er13.appf.tab2_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_3 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab2_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_4 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_5 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_6 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#niceng180er13.appf.tab2_2">2</a></sup></td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_7 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_2 hd_h_niceng180er13.appf.tab2_1_1_2_8 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>7/31</p>
|
||
<p>(22.6%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_2 hd_h_niceng180er13.appf.tab2_1_1_2_9 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">22.6%</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_3 hd_h_niceng180er13.appf.tab2_1_1_2_10 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 3.39 (0.76 to 15.02)</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_3 hd_h_niceng180er13.appf.tab2_1_1_2_11 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">540 more per 1000 (from 54 fewer to 1000 more)</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_4 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁◯◯◯</p>
|
||
<p>VERY LOW</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_5 hd_b_niceng180er13.appf.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_1 hd_h_niceng180er13.appf.tab2_1_1_2_2 hd_h_niceng180er13.appf.tab2_1_1_2_3 hd_h_niceng180er13.appf.tab2_1_1_2_4 hd_h_niceng180er13.appf.tab2_1_1_2_5 hd_h_niceng180er13.appf.tab2_1_1_2_6 hd_h_niceng180er13.appf.tab2_1_1_2_7 hd_h_niceng180er13.appf.tab2_1_1_1_2 hd_h_niceng180er13.appf.tab2_1_1_2_8 hd_h_niceng180er13.appf.tab2_1_1_2_9 hd_h_niceng180er13.appf.tab2_1_1_1_3 hd_h_niceng180er13.appf.tab2_1_1_2_10 hd_h_niceng180er13.appf.tab2_1_1_2_11 hd_h_niceng180er13.appf.tab2_1_1_1_4 hd_h_niceng180er13.appf.tab2_1_1_1_5" id="hd_b_niceng180er13.appf.tab2_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Post-operative complications</th></tr><tr><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_1 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_2 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies<sup><a class="bk_pop" href="#niceng180er13.appf.tab2_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_3 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab2_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_4 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_5 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_6 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_1 hd_h_niceng180er13.appf.tab2_1_1_2_7 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_2 hd_h_niceng180er13.appf.tab2_1_1_2_8 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>26/31</p>
|
||
<p>(83.9%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_2 hd_h_niceng180er13.appf.tab2_1_1_2_9 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>13/30</p>
|
||
<p>(43.3%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_3 hd_h_niceng180er13.appf.tab2_1_1_2_10 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.94 (1.25 to 3)</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_3 hd_h_niceng180er13.appf.tab2_1_1_2_11 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">407 more per 1000 (from 108 more to 867 more)</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_4 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁⨁◯◯</p>
|
||
<p>LOW</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab2_1_1_1_5 hd_b_niceng180er13.appf.tab2_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng180er13.appf.tab2_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design</p></div></dd><dt>2</dt><dd><div id="niceng180er13.appf.tab2_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></div></div></div><div id="niceng180er13.appf.tab3" class="table"><h3><span class="label">Table 20</span><span class="title">Clinical evidence profile: ICU compared to surgical ward for adults undergoing surgery – high risk; elective</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appf.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appf.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.appf.tab3_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng180er13.appf.tab3_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng180er13.appf.tab3_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng180er13.appf.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab3_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng180er13.appf.tab3_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab3_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1" id="hd_h_niceng180er13.appf.tab3_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_2" id="hd_h_niceng180er13.appf.tab3_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">ICU compared to surgical ward</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_2" id="hd_h_niceng180er13.appf.tab3_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Control</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_3" id="hd_h_niceng180er13.appf.tab3_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_3" id="hd_h_niceng180er13.appf.tab3_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_1 hd_h_niceng180er13.appf.tab3_1_1_2_2 hd_h_niceng180er13.appf.tab3_1_1_2_3 hd_h_niceng180er13.appf.tab3_1_1_2_4 hd_h_niceng180er13.appf.tab3_1_1_2_5 hd_h_niceng180er13.appf.tab3_1_1_2_6 hd_h_niceng180er13.appf.tab3_1_1_2_7 hd_h_niceng180er13.appf.tab3_1_1_1_2 hd_h_niceng180er13.appf.tab3_1_1_2_8 hd_h_niceng180er13.appf.tab3_1_1_2_9 hd_h_niceng180er13.appf.tab3_1_1_1_3 hd_h_niceng180er13.appf.tab3_1_1_2_10 hd_h_niceng180er13.appf.tab3_1_1_2_11 hd_h_niceng180er13.appf.tab3_1_1_1_4 hd_h_niceng180er13.appf.tab3_1_1_1_5" id="hd_b_niceng180er13.appf.tab3_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality</th></tr><tr><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_1 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_2 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies<sup><a class="bk_pop" href="#niceng180er13.appf.tab3_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_3 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab3_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_4 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_5 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_6 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#niceng180er13.appf.tab3_2">2</a></sup></td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_7 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_2 hd_h_niceng180er13.appf.tab3_1_1_2_8 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>2/51</p>
|
||
<p>(3.9%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_2 hd_h_niceng180er13.appf.tab3_1_1_2_9 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.6%</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_3 hd_h_niceng180er13.appf.tab3_1_1_2_10 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 1.53 (0.14 to 16.26)</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_3 hd_h_niceng180er13.appf.tab3_1_1_2_11 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">14 more per 1000 (from 22 fewer to 397 more)</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_4 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁◯◯◯</p>
|
||
<p>VERY LOW</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_5 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_1 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_2 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies<sup><a class="bk_pop" href="#niceng180er13.appf.tab3_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_3 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab3_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_4 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_5 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_6 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_1 hd_h_niceng180er13.appf.tab3_1_1_2_7 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_2 hd_h_niceng180er13.appf.tab3_1_1_2_8 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>0/51</p>
|
||
<p>(0%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_2 hd_h_niceng180er13.appf.tab3_1_1_2_9 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">17.9%</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_3 hd_h_niceng180er13.appf.tab3_1_1_2_10 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">Peto OR 0.08 (0.02 to 0.4)</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_3 hd_h_niceng180er13.appf.tab3_1_1_2_11 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">165 fewer per 1000 (from 108 to 176 fewer)</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_4 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁⨁◯◯</p>
|
||
<p>LOW</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab3_1_1_1_5 hd_b_niceng180er13.appf.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng180er13.appf.tab3_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design</p></div></dd><dt>2</dt><dd><div id="niceng180er13.appf.tab3_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd></dl></div></div></div><div id="niceng180er13.appf.tab4" class="table"><h3><span class="label">Table 21</span><span class="title">Clinical evidence profile: HDU compared to surgical ward for adults undergoing surgery – low/intermediate risk; elective</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appf.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appf.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.appf.tab4_1_1_1_1" colspan="7" rowspan="1" style="text-align:center;vertical-align:middle;">Quality assessment</th><th id="hd_h_niceng180er13.appf.tab4_1_1_1_2" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">No of patients</th><th id="hd_h_niceng180er13.appf.tab4_1_1_1_3" colspan="2" rowspan="1" style="text-align:center;vertical-align:middle;">Effect</th><th id="hd_h_niceng180er13.appf.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab4_1_1_1_4" style="text-align:center;vertical-align:middle;">Quality</th><th id="hd_h_niceng180er13.appf.tab4_1_1_1_5" rowspan="2" colspan="1" headers="hd_h_niceng180er13.appf.tab4_1_1_1_5" style="text-align:center;vertical-align:middle;">Importance</th></tr><tr><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">No of studies</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Design</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_3" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Risk of bias</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_4" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Inconsistency</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_5" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Indirectness</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_6" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Imprecision</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1" id="hd_h_niceng180er13.appf.tab4_1_1_2_7" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Other considerations</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_2" id="hd_h_niceng180er13.appf.tab4_1_1_2_8" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Low risk - HDU</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_2" id="hd_h_niceng180er13.appf.tab4_1_1_2_9" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Surgical ward</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_3" id="hd_h_niceng180er13.appf.tab4_1_1_2_10" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Relative (95% CI)</th><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_3" id="hd_h_niceng180er13.appf.tab4_1_1_2_11" rowspan="1" colspan="1" style="text-align:center;vertical-align:middle;">Absolute</th></tr></thead><tbody><tr><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_1 hd_h_niceng180er13.appf.tab4_1_1_2_2 hd_h_niceng180er13.appf.tab4_1_1_2_3 hd_h_niceng180er13.appf.tab4_1_1_2_4 hd_h_niceng180er13.appf.tab4_1_1_2_5 hd_h_niceng180er13.appf.tab4_1_1_2_6 hd_h_niceng180er13.appf.tab4_1_1_2_7 hd_h_niceng180er13.appf.tab4_1_1_1_2 hd_h_niceng180er13.appf.tab4_1_1_2_8 hd_h_niceng180er13.appf.tab4_1_1_2_9 hd_h_niceng180er13.appf.tab4_1_1_1_3 hd_h_niceng180er13.appf.tab4_1_1_2_10 hd_h_niceng180er13.appf.tab4_1_1_2_11 hd_h_niceng180er13.appf.tab4_1_1_1_4 hd_h_niceng180er13.appf.tab4_1_1_1_5" id="hd_b_niceng180er13.appf.tab4_1_1_1_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Mortality (follow-up 30 days)</th></tr><tr><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_1 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_2 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_3 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab4_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_4 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_5 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_6 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">very serious<sup><a class="bk_pop" href="#niceng180er13.appf.tab4_2">2</a></sup></td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_7 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">none</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_2 hd_h_niceng180er13.appf.tab4_1_1_2_8 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>1/68</p>
|
||
<p>(1.5%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_2 hd_h_niceng180er13.appf.tab4_1_1_2_9 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">2.2%</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_3 hd_h_niceng180er13.appf.tab4_1_1_2_10 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">RR 0.68 (0.07 to 6.43)</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_3 hd_h_niceng180er13.appf.tab4_1_1_2_11 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">7 fewer per 1000 (from 20 fewer to 119 more)</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_4 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁◯◯◯</p>
|
||
<p>VERY LOW</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_5 hd_b_niceng180er13.appf.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr><tr><th headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_1 hd_h_niceng180er13.appf.tab4_1_1_2_2 hd_h_niceng180er13.appf.tab4_1_1_2_3 hd_h_niceng180er13.appf.tab4_1_1_2_4 hd_h_niceng180er13.appf.tab4_1_1_2_5 hd_h_niceng180er13.appf.tab4_1_1_2_6 hd_h_niceng180er13.appf.tab4_1_1_2_7 hd_h_niceng180er13.appf.tab4_1_1_1_2 hd_h_niceng180er13.appf.tab4_1_1_2_8 hd_h_niceng180er13.appf.tab4_1_1_2_9 hd_h_niceng180er13.appf.tab4_1_1_1_3 hd_h_niceng180er13.appf.tab4_1_1_2_10 hd_h_niceng180er13.appf.tab4_1_1_2_11 hd_h_niceng180er13.appf.tab4_1_1_1_4 hd_h_niceng180er13.appf.tab4_1_1_1_5" id="hd_b_niceng180er13.appf.tab4_1_1_3_1" colspan="13" rowspan="1" style="text-align:left;vertical-align:top;">Post-operative complication: emergency laparotomy (follow-up postoperatively)</th></tr><tr><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_1 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_2 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">observational studies</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_3 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious risk of bias<sup><a class="bk_pop" href="#niceng180er13.appf.tab4_1">1</a></sup></td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_4 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious inconsistency</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_5 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious indirectness</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_6 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">no serious imprecision</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_1 hd_h_niceng180er13.appf.tab4_1_1_2_7 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">strong association<sup><a class="bk_pop" href="#niceng180er13.appf.tab4_3">3</a></sup></td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_2 hd_h_niceng180er13.appf.tab4_1_1_2_8 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>0/68</p>
|
||
<p>(0%)</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_2 hd_h_niceng180er13.appf.tab4_1_1_2_9 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">10.1%</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_3 hd_h_niceng180er13.appf.tab4_1_1_2_10 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">OR 0.2 (0.06 to 0.65)</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_3 hd_h_niceng180er13.appf.tab4_1_1_2_11 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">79 fewer per 1000 (from 33 fewer to 94 fewer)</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_4 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">
|
||
<p>⨁⨁⨁◯</p>
|
||
<p>MODERATE</p>
|
||
</td><td headers="hd_h_niceng180er13.appf.tab4_1_1_1_5 hd_b_niceng180er13.appf.tab4_1_1_3_1" rowspan="1" colspan="1" style="text-align:center;vertical-align:top;">CRITICAL</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>1</dt><dd><div id="niceng180er13.appf.tab4_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design</p></div></dd><dt>2</dt><dd><div id="niceng180er13.appf.tab4_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs</p></div></dd><dt>3</dt><dd><div id="niceng180er13.appf.tab4_3"><p class="no_margin">Upgraded by 1 increment if the magnitude of effect is large (OR = 2–5 or OR = 0.5–0.2) or by 2 increments if the magnitude of effect is very large (OR > 5 or OR < 0.2)</p></div></dd></dl></div></div></div></div><div id="niceng180er13.appg"><h3>Appendix G. Health economic evidence selection</h3><div id="niceng180er13.appg.fig1" class="figure bk_fig"><div class="graphic"><a href="/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%209.%20Flow%20chart%20of%20HE%20study%20selection%20for%20the%20review%20of%20specialist%20recovery%20areas.&p=BOOKS&id=561964_niceng180er13appgf1.jpg" target="tileshopwindow" class="inline_block pmc_inline_block ts_canvas img_link" title="Click on image to zoom"><div class="ts_bar small" title="Click on image to zoom"></div><img src="/books/NBK561964/bin/niceng180er13appgf1.jpg" alt="Figure 9. Flow chart of HE study selection for the review of specialist recovery areas." class="tileshop" title="Click on image to zoom" /></a></div><h3><span class="label">Figure 9</span><span class="title">Flow chart of HE study selection for the review of specialist recovery areas</span></h3><div class="caption"><p>* Non-relevant population, intervention, comparison, design or setting; non-English language</p></div></div></div><div id="niceng180er13.apph"><h3>Appendix H. Health economic evidence tables</h3><p id="niceng180er13.apph.et1"><a href="/books/NBK561964/bin/niceng180er13-apph-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (154K)</span></p></div><div id="niceng180er13.appi"><h3>Appendix I. Excluded studies</h3><div id="niceng180er13.appi.s1"><h4>I.1. Excluded clinical studies</h4><div id="niceng180er13.appi.tab1" class="table"><h3><span class="label">Table 22</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appi.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appi.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference</th><th id="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Carter 2012<a class="bk_pop" href="#niceng180er13.ref2"><sup>2</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Dalziel 2001<a class="bk_pop" href="#niceng180er13.ref4"><sup>4</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">De Almeida 2018<a class="bk_pop" href="#niceng180er13.ref5"><sup>5</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Treatment for neurosurgery</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NCT 2015<a class="bk_pop" href="#niceng180er13.ref10"><sup>10</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Citation only</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NCT 2017<a class="bk_pop" href="#niceng180er13.ref11"><sup>11</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Citation only</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Pedoto 2009<a class="bk_pop" href="#niceng180er13.ref14"><sup>14</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate study design</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Shan 2013<a class="bk_pop" href="#niceng180er13.ref15"><sup>15</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not review population</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turner 2002<a class="bk_pop" href="#niceng180er13.ref18"><sup>18</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not available</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Turner 2003<a class="bk_pop" href="#niceng180er13.ref19"><sup>19</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Systematic review: no evidence identified</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Vester-Andersen 2015<a class="bk_pop" href="#niceng180er13.ref20"><sup>20</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inappropriate comparison</td></tr><tr><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">White 2003<a class="bk_pop" href="#niceng180er13.ref21"><sup>21</sup></a></td><td headers="hd_h_niceng180er13.appi.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incorrect interventions</td></tr></tbody></table></div></div></div><div id="niceng180er13.appi.s2"><h4>I.2. Excluded health economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2003 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><div id="niceng180er13.appi.tab2" class="table"><h3><span class="label">Table 23</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appi.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appi.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reference</th><th id="hd_h_niceng180er13.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.appi.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None.</td><td headers="hd_h_niceng180er13.appi.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></div></div><div id="niceng180er13.appj"><h3>Appendix J. Research recommendations</h3><div id="niceng180er13.appj.s1"><h4>J.1. Specialist recovery areas</h4><div id="niceng180er13.appj.s1.1"><h5>Research question: Which patients, other than those known to have a high risk of complications or mortality, would benefit from postoperative care in a specialist recovery area (a high-dependency unit, a post-anaesthesia unit or an intensive care unit)?</h5><p>
|
||
<b>Why this is important:</b>
|
||
</p><p>The increasing medical complexity of patients presenting for surgery and the vast array of surgical procedures possible are changing the landscape of perioperative care. The needs of such patients in the post-operative phase (during which most complications and factors relating to poor outcomes occur) can be highly diverse depending on these patient factors and the nature of their surgery. Rationalising the limited resources of specialist areas is additionally a key imperative. Predicting pre operatively which patients will require specialist recovery areas is an inexact science and supported by limited evidence. A better understanding of this would allow more rational, bespoke and cost effective solutions for resource allocation while ensuring appropriate care levels are correctly provided.</p><div id="niceng180er13.appj.tab1" class="table"><h3><span class="title">Criteria for selecting high-priority research recommendations</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.appj.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.appj.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PICO question</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Population: Adults 18 years and over having major surgery.</p><p>Stratified by:
|
||
<ul><li class="half_rhythm"><div>Type/ nature/ complexity of surgical procedure</div></li><li class="half_rhythm"><div>Complexity of comorbid medical illness</div></li><li class="half_rhythm"><div>Outcome of preoperative risk assessment</div></li></ul></p>
|
||
<p>Intervention(s):
|
||
<ul><li class="half_rhythm"><div>Level 2 (High Dependency Unit, Post-Anaesthesia Care Unit)</div></li><li class="half_rhythm"><div>Level 3 (Intensive Care Unit)</div></li></ul></p>
|
||
<p>Comparison:
|
||
<ul><li class="half_rhythm"><div>Level 0 (postoperative recovery on a surgical ward)</div></li><li class="half_rhythm"><div>Level 1 (postoperative recovery on a surgical ward with access to a Critical Care Outreach Team)</div></li><li class="half_rhythm"><div>Compared to each other</div></li></ul></p>
|
||
<p>Outcome(s): Health-related quality of life, mortality, adverse events and complications (Clavien-Dindo, postoperative morbidity score (POMS)), unplanned intensive care unit admission/readmission, length of hospital stay, hospital readmission, postponed/cancelled surgery and patient/family/carer experience of care.</p></td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance to patients or the population</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">While it is often clear at the varying ends of the spectrum whether patients specifically do or do not require level 2 or 3 care, there is a large population of surgical patients where these decisions are unclear. It is important that the decisions for post-operative destination are appropriately rationalised given the resources are limited and potentially costly. There exists limited evidence and guidance for such decisions and when they are made on seemingly arbitrary criteria like age or ASA grade there is a propensity to over or under triage for this resource. Furthermore the value-add of specialist areas for postoperative care in some contexts is unclear and difficult to measure particularly if the surgery has been routine or unproblematic. Conversely some patients are not selected for recovery in specialist areas when their combination of factors surrounding their surgery may indicate higher risk for post-operative complications.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to NICE guidance</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">There is currently no evidence or guidance on how best to approach selecting patients for specialist recovery areas and rationalisation of this limited resource.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relevance to the NHS</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Research in this area will inform NICE recommendations for service delivery and provide information about clinical and cost-effectiveness.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">National priorities</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Rationalisation of Specialist Recovery Areas as a resource will have financial implications on the NHS and nationally.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Current evidence base</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Three small non-randomised studies comparing ICU with a post-anaesthesia care unit/specialist area or surgical ward were identified. There was insufficient evidence to make a recommendation. There exists a gap in well-defined research criteria and this is an area for benchmarking relevant criteria against which this can be studied.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Equality</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_7_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not applicable</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_8_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">A randomised study would be difficult to perform for this area. Well conducted prospective cohort studies which benchmark usable criteria for patient selection would be valuable.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Feasibility</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_9_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Doing good research in this field is particularly difficult because of the heterogeneity of the population and the heterogeneity of types of surgery.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other comments</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_10_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The committee is aware this is a complex area for a research study that will provide something useful and representative.</td></tr><tr><th id="hd_b_niceng180er13.appj.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Importance</th><td headers="hd_b_niceng180er13.appj.tab1_1_1_11_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Medium: the research is relevant to the recommendations in the guideline and would be useful to future updates.</div></li></ul></td></tr></tbody></table></div></div></div></div></div></div><div class="bk_prnt_sctn"><h2>Tables</h2><div class="whole_rhythm bk_prnt_obj bk_first_prnt_obj"><div id="niceng180er13.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng180er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng180er13.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Adults 18 years and over having major surgery.</td></tr><tr><th id="hd_b_niceng180er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention</th><td headers="hd_b_niceng180er13.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Postoperative recovery in specialist areas
|
||
<ul><li class="half_rhythm"><div>level 2 (high dependency unit, post-anaesthesia care unit)</div></li><li class="half_rhythm"><div>level 3 (intensive care unit)</div></li></ul></td></tr><tr><th id="hd_b_niceng180er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison</th><td headers="hd_b_niceng180er13.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>each other</div></li><li class="half_rhythm"><div>level 0 (postoperative recovery on a surgical ward)</div></li><li class="half_rhythm"><div>level 1 (postoperative recovery on a surgical ward with access to a critical care outreach team)</div></li></ul></td></tr><tr><th id="hd_b_niceng180er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes</th><td headers="hd_b_niceng180er13.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Critical outcomes:
|
||
<ul><li class="half_rhythm"><div>health-related quality of life</div></li><li class="half_rhythm"><div>mortality</div></li><li class="half_rhythm"><div>adverse events and complications (Clavien-Dindo, postoperative morbidity score (POMS))</div></li><li class="half_rhythm"><div>unplanned intensive care unit admission/readmission</div></li></ul>
|
||
Important outcomes:
|
||
<ul><li class="half_rhythm"><div>length of hospital stay</div></li><li class="half_rhythm"><div>hospital readmission</div></li><li class="half_rhythm"><div>postponed/cancelled surgery</div></li><li class="half_rhythm"><div>patient/family/carer experience of care</div></li></ul></td></tr><tr><th id="hd_b_niceng180er13.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng180er13.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Randomised controlled trials (RCTs), systematic reviews of RCTs.</p>
|
||
<p>Observational studies if no RCT evidence is identified.</p>
|
||
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Study</th><th id="hd_h_niceng180er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Intervention and comparison</th><th id="hd_h_niceng180er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Population</th><th id="hd_h_niceng180er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Outcomes</th><th id="hd_h_niceng180er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:middle;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arshad 2014<a class="bk_pop" href="#niceng180er13.ref1"><sup>1</sup></a></td><td headers="hd_h_niceng180er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p><b>ICU:</b> patients were taken directly to the ICU after surgery. Patients often remained sedated and on mechanical ventilation until deemed ready for weaning by the ICU and primary teams. The head and neck surgical staff instructed the ICU nurse as to the location and appearance of the flap and the appropriate Doppler signal.</p>
|
||
<p>N=119</p>
|
||
<p><b>PACU/specialist area:</b> after the patient came out of the operating room, he/she went directly to the post-anaesthesia care unit (PACU) off of mechanical ventilation. Then the floor nurse responsible for the patient’s care would come to the PACU and assess the flap appearance and Doppler signal with the surgeons. The patient would then be transferred to the specialty floor after discharge from the PACU.</p>
|
||
<p>N=125</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>High risk; elective</p>
|
||
<p>Patients undergoing free flap surgery for head and neck defects.</p>
|
||
<p>Mean age: 59 years</p>
|
||
<p>USA</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Length of hospital stay (days)</div></li><li class="half_rhythm"><div>Complications</div></li><li class="half_rhythm"><div>unplanned intensive care unit admission/readmission</div></li></ul></td><td headers="hd_h_niceng180er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Retrospective cohort study; before and after implementation of specialist area.</p>
|
||
<p>A specialty specific floor was defined as a dedicated ward of the hospital where patients with head and neck cancer typically recover postoperatively.</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Curran 1998<a class="bk_pop" href="#niceng180er13.ref3"><sup>3</sup></a></td><td headers="hd_h_niceng180er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p><b>ICU</b>: Post-operative admission to ITU</p>
|
||
<p>N=31</p>
|
||
<p><b>Surgical ward:</b> No admission to the ITU (no more information)</p>
|
||
<p>N=30</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>High risk; elective & emergency</p>
|
||
<p>All general surgical and vascular patients who had an operation lasting longer than 90 minutes or who were aged ≥70 years having a major surgery during the winter period from December to February, and meeting the criteria for perioperative enhanced delivery.</p>
|
||
<p>Mean age (SEM): 71 years (2.6)</p>
|
||
<p>UK</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Complications</div></li><li class="half_rhythm"><div>Length of hospital stay</div></li></ul></td><td headers="hd_h_niceng180er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><p>Retrospective cohort study</p><p>Criteria for enhancement of oxygen delivery. Operation planned to exceed 90minutes and has ≥one of:
|
||
<ul><li class="half_rhythm"><div>Previous severe cardiorespiratory illness — acute myocardial infarction, chronic obstructive pulmonary disease, or stroke</div></li><li class="half_rhythm"><div>Respiratory failure: PaO2 <8.0 kPa on FIO2 >0.4 or mechanical ventilation > 48 hours</div></li><li class="half_rhythm"><div>Shock (MAP <60mmHg, CVP <15mmHG, urine output <20ml h, cold and clammy)</div></li><li class="half_rhythm"><div>Acute abdominal catastrophe with haemodynamic instability (e.g. peritonitis, perforated viscus, pancreatitis)</div></li><li class="half_rhythm"><div>Acute massive blood loss > 8 units</div></li><li class="half_rhythm"><div>Age > 70 years with limited physiological reserve in one or more vital organs</div></li><li class="half_rhythm"><div>Acute renal failure: urea > 20 mmol/l or creatinine > 260 mmol/l</div></li><li class="half_rhythm"><div>Extensive surgery for carcinoma (e.g. oesophagectomy, gastrectomy cystectomy)</div></li><li class="half_rhythm"><div>Late-stage vascular disease involving aorta</div></li></ul></p>
|
||
<p>Patients not admitted to ITU had the lowest mean number of criteria. Patients admitted to ITU also had a higher ASA and POSSUM score. These differences were significant.</p></td></tr><tr><td headers="hd_h_niceng180er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Swart 2012<a class="bk_pop" href="#niceng180er13.ref16"><sup>16</sup></a></td><td headers="hd_h_niceng180er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p><b>ICU:</b> Critical care provided more frequent monitoring than ward care, including hourly determination of pulse, blood pressure, pulse oximetry, respiratory rate and urine output. There was an increased nurse and doctor to patient ratio on the CCU. The intended CCU stay was for the first postoperative night.</p>
|
||
<p>N=51</p>
|
||
<p><b>Surgical ward:</b> Patients received postoperative care in the surgical ward.</p>
|
||
<p>N=39</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>High risk; elective care</p>
|
||
<p>Patients aged ≥45 years scheduled for elective open colorectal resection.</p>
|
||
<p>Mean age (SD): 72.9 years (8.1)</p>
|
||
<p>UK</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Complications</div></li><li class="half_rhythm"><div>Length of hospital stay</div></li></ul></td><td headers="hd_h_niceng180er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cohort study</p>
|
||
<p>Patients expected to require postoperative critical care were excluded.</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Swart 2017<a class="bk_pop" href="#niceng180er13.ref17"><sup>17</sup></a></td><td headers="hd_h_niceng180er13.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p><b>HDU:</b> Planned HDU postoperative care. Postoperative care was provided on a 10-bed critical care unit (a combined adult general intensive care and HDU)</p>
|
||
<p>N=68</p>
|
||
<p><b>Ward:</b> Planned Ward postoperative care. Postoperative care was provided on a 24-bed colorectal surgical ward.</p>
|
||
<p>N=139</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Low/intermediate risk; elective surgery</p>
|
||
<p>Cohort of patients undergoing elective colorectal surgery, whose planned postoperative care was determined by their predicted 30 day mortality. People with a 1–3% risk of 30 day mortality were included for analysis.</p>
|
||
<p>Mean age (SD): 72 years (7)</p>
|
||
<p>UK</p>
|
||
</td><td headers="hd_h_niceng180er13.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Mortality</div></li><li class="half_rhythm"><div>Unplanned intensive care unit admission/readmission</div></li><li class="half_rhythm"><div>Post-operative complications</div></li></ul></td><td headers="hd_h_niceng180er13.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Prospective cohort study</p>
|
||
<p>For predicted 30 day mortalities of 1–3% (i.e. intermediate risk), an HDU bed was booked but surgery could proceed if an HDU bed was unavailable on the day of the operation.</p>
|
||
</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: ICU compared to PACU for adults undergoing surgery – high risk; elective surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab3_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab3_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng180er13.tab3_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab3_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng180er13.tab3_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab3_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng180er13.tab3_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab3_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng180er13.tab3_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng180er13.tab3_1_1_1_5" id="hd_h_niceng180er13.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_niceng180er13.tab3_1_1_1_5" id="hd_h_niceng180er13.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with ICU compared to PACU (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng180er13.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>244</p>
|
||
<p>(1 study)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab3_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊕⊝⊝</p>
|
||
<p>LOW<sup><a class="bk_pop" href="#niceng180er13.tab3_1">1</a></sup></p>
|
||
<p>due to study design</p>
|
||
</td><td headers="hd_h_niceng180er13.tab3_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Not estimable</td><td headers="hd_h_niceng180er13.tab3_1_1_1_5 hd_h_niceng180er13.tab3_1_1_2_1 hd_h_niceng180er13.tab3_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab3_1_1_1_5 hd_h_niceng180er13.tab3_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0 per 1000</td><td headers="hd_h_niceng180er13.tab3_1_1_1_5 hd_h_niceng180er13.tab3_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">-</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>(a)</dt><dd><div id="niceng180er13.tab3_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design.</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: ICU compared to surgical ward for adults undergoing surgery – high risk; elective & emergency surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab4_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab4_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng180er13.tab4_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab4_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng180er13.tab4_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab4_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng180er13.tab4_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab4_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng180er13.tab4_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng180er13.tab4_1_1_1_5" id="hd_h_niceng180er13.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_niceng180er13.tab4_1_1_1_5" id="hd_h_niceng180er13.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with ICU compared to surgical ward (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng180er13.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>61</p>
|
||
<p>(1 study)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊝⊝⊝</p>
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#niceng180er13.tab4_1">1</a></sup><sup>,</sup><sup><a class="bk_pop" href="#niceng180er13.tab4_2">2</a></sup></p>
|
||
<p>due to imprecision</p>
|
||
</td><td headers="hd_h_niceng180er13.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 3.39 (0.76 to 15.02)</td><td headers="hd_h_niceng180er13.tab4_1_1_1_5 hd_h_niceng180er13.tab4_1_1_2_1 hd_h_niceng180er13.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab4_1_1_1_5 hd_h_niceng180er13.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">226 per 1000</td><td headers="hd_h_niceng180er13.tab4_1_1_1_5 hd_h_niceng180er13.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">540 more per 1000 (from 54 fewer to 1000 more)</td></tr><tr><td headers="hd_h_niceng180er13.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Post-operative complications</td><td headers="hd_h_niceng180er13.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>61</p>
|
||
<p>(1 study)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab4_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊕⊝⊝</p>
|
||
<p>LOW<sup><a class="bk_pop" href="#niceng180er13.tab4_1">1</a></sup></p>
|
||
<p>due to study design</p>
|
||
</td><td headers="hd_h_niceng180er13.tab4_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.94 (1.25 to 3)</td><td headers="hd_h_niceng180er13.tab4_1_1_1_5 hd_h_niceng180er13.tab4_1_1_2_1 hd_h_niceng180er13.tab4_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab4_1_1_1_5 hd_h_niceng180er13.tab4_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">433 per 1000</td><td headers="hd_h_niceng180er13.tab4_1_1_1_5 hd_h_niceng180er13.tab4_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">407 more per 1000 (from 108 more to 866 more)</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>(a)</dt><dd><div id="niceng180er13.tab4_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design.</p></div></dd><dt>(b)</dt><dd><div id="niceng180er13.tab4_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Clinical evidence summary: ICU compared to surgical ward for adults undergoing surgery – high risk; elective surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab5_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab5_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng180er13.tab5_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab5_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng180er13.tab5_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab5_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng180er13.tab5_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab5_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng180er13.tab5_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng180er13.tab5_1_1_1_5" id="hd_h_niceng180er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Control</th><th headers="hd_h_niceng180er13.tab5_1_1_1_5" id="hd_h_niceng180er13.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with ICU compared to surgical ward (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng180er13.tab5_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>90</p>
|
||
<p>(1 study)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab5_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊝⊝⊝</p>
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#niceng180er13.tab5_1">1</a></sup><sup>,</sup><sup><a class="bk_pop" href="#niceng180er13.tab5_2">2</a></sup></p>
|
||
<p>due to study design and imprecision</p>
|
||
</td><td headers="hd_h_niceng180er13.tab5_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 1.53 (0.14 to 16.26)</td><td headers="hd_h_niceng180er13.tab5_1_1_1_5 hd_h_niceng180er13.tab5_1_1_2_1 hd_h_niceng180er13.tab5_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab5_1_1_1_5 hd_h_niceng180er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">26 per 1000</td><td headers="hd_h_niceng180er13.tab5_1_1_1_5 hd_h_niceng180er13.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">14 more per 1000 (from 22 fewer to 397 more)</td></tr><tr><td headers="hd_h_niceng180er13.tab5_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Post-operative complications</td><td headers="hd_h_niceng180er13.tab5_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>90</p>
|
||
<p>(1 study)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab5_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊕⊝⊝⊝</p>
|
||
<p>LOW<sup><a class="bk_pop" href="#niceng180er13.tab5_1">1</a></sup></p>
|
||
<p>due to study design</p>
|
||
</td><td headers="hd_h_niceng180er13.tab5_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Peto OR 0.08 (0.02 to 0.4)</td><td headers="hd_h_niceng180er13.tab5_1_1_1_5 hd_h_niceng180er13.tab5_1_1_2_1 hd_h_niceng180er13.tab5_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab5_1_1_1_5 hd_h_niceng180er13.tab5_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">179 per 1000</td><td headers="hd_h_niceng180er13.tab5_1_1_1_5 hd_h_niceng180er13.tab5_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">165 fewer per 1000 (from 108 to 176 fewer)</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>(a)</dt><dd><div id="niceng180er13.tab5_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design.</p></div></dd><dt>(b)</dt><dd><div id="niceng180er13.tab5_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab6" class="table"><h3><span class="label">Table 6</span><span class="title">Clinical evidence summary: HDU compared to surgical ward for adults undergoing surgery – low/intermediate risk; elective surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab6/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab6_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab6_1_1_1_1" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab6_1_1_1_1" style="text-align:left;vertical-align:bottom;">Outcomes</th><th id="hd_h_niceng180er13.tab6_1_1_1_2" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab6_1_1_1_2" style="text-align:left;vertical-align:bottom;">No of Participants (studies) Follow up</th><th id="hd_h_niceng180er13.tab6_1_1_1_3" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab6_1_1_1_3" style="text-align:left;vertical-align:bottom;">Quality of the evidence (GRADE)</th><th id="hd_h_niceng180er13.tab6_1_1_1_4" rowspan="2" colspan="1" headers="hd_h_niceng180er13.tab6_1_1_1_4" style="text-align:left;vertical-align:bottom;">Relative effect (95% CI)</th><th id="hd_h_niceng180er13.tab6_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Anticipated absolute effects</th></tr><tr><th headers="hd_h_niceng180er13.tab6_1_1_1_5" id="hd_h_niceng180er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk with Surgical ward</th><th headers="hd_h_niceng180er13.tab6_1_1_1_5" id="hd_h_niceng180er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Risk difference with Low risk - HDU (95% CI)</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Mortality</td><td headers="hd_h_niceng180er13.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>207</p>
|
||
<p>(1 study)</p>
|
||
<p>30 days</p>
|
||
</td><td headers="hd_h_niceng180er13.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊝⊝⊝</p>
|
||
<p>VERY LOW<sup><a class="bk_pop" href="#niceng180er13.tab6_1">1</a></sup><sup>,</sup><sup><a class="bk_pop" href="#niceng180er13.tab6_2">2</a></sup></p>
|
||
<p>due to study design and imprecision</p>
|
||
</td><td headers="hd_h_niceng180er13.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">RR 0.68 (0.07 to 6.43)</td><td headers="hd_h_niceng180er13.tab6_1_1_1_5 hd_h_niceng180er13.tab6_1_1_2_1 hd_h_niceng180er13.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab6_1_1_1_5 hd_h_niceng180er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">22 per 1000</td><td headers="hd_h_niceng180er13.tab6_1_1_1_5 hd_h_niceng180er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">7 fewer per 1000 (from 20 fewer to 119 more)</td></tr><tr><td headers="hd_h_niceng180er13.tab6_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">Post-operative complication: emergency laparotomy</td><td headers="hd_h_niceng180er13.tab6_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>207</p>
|
||
<p>(1 study)</p>
|
||
<p>postoperatively</p>
|
||
</td><td headers="hd_h_niceng180er13.tab6_1_1_1_3" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>⊕⊕⊕⊝</p>
|
||
<p>MODERATE<sup><a class="bk_pop" href="#niceng180er13.tab6_1">1</a></sup><sup>,</sup><sup><a class="bk_pop" href="#niceng180er13.tab6_3">3</a></sup></p>
|
||
<p>due to study design and large effect</p>
|
||
</td><td headers="hd_h_niceng180er13.tab6_1_1_1_4" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">OR 0.2 (0.06 to 0.65)</td><td headers="hd_h_niceng180er13.tab6_1_1_1_5 hd_h_niceng180er13.tab6_1_1_2_1 hd_h_niceng180er13.tab6_1_1_2_2" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Moderate</td></tr><tr><td headers="hd_h_niceng180er13.tab6_1_1_1_5 hd_h_niceng180er13.tab6_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">101 per 1000</td><td headers="hd_h_niceng180er13.tab6_1_1_1_5 hd_h_niceng180er13.tab6_1_1_2_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">79 fewer per 1000 (from 33 fewer to 94 fewer)</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>(a)</dt><dd><div id="niceng180er13.tab6_1"><p class="no_margin">Downgraded by 2 increments if the majority of the evidence was from studies with observational/non-randomised study design.</p></div></dd><dt>(b)</dt><dd><div id="niceng180er13.tab6_2"><p class="no_margin">Downgraded by 1 increment if the confidence interval crossed one MID or by 2 increments if the confidence interval crossed both MIDs.</p></div></dd><dt>(c)</dt><dd><div id="niceng180er13.tab6_3"><p class="no_margin">Upgraded by 1 increment if the magnitude of effect is large (OR = 2–5 or OR = 0.5–0.2) or by 2 increments if the magnitude of effect is very large (OR > 5 or OR < 0.2)</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab7" class="table"><h3><span class="label">Table 7</span><span class="title">Evidence not suitable for GRADE analysis: ICU compared to PACU/specialty ward – high risk; elective surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab7/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab7_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><th id="hd_h_niceng180er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study (no. of participants)</th><th id="hd_h_niceng180er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng180er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PACU results</th><th id="hd_h_niceng180er13.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICU results</th><th id="hd_h_niceng180er13.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><i>P</i> value</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of hospital stay (days)</td><td headers="hd_h_niceng180er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arshad 2014 (244)</td><td headers="hd_h_niceng180er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_niceng180er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median: 8</td><td headers="hd_h_niceng180er13.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median: 9</td><td headers="hd_h_niceng180er13.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.008</td></tr><tr><td headers="hd_h_niceng180er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Complications</td><td headers="hd_h_niceng180er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arshad 2014 (244)</td><td headers="hd_h_niceng180er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_niceng180er13.tab7_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median: 1</td><td headers="hd_h_niceng180er13.tab7_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median: 1</td><td headers="hd_h_niceng180er13.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.67</td></tr><tr><td headers="hd_h_niceng180er13.tab7_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unplanned intensive care unit admission/readmis sion</td><td headers="hd_h_niceng180er13.tab7_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Arshad 2014 (244)</td><td headers="hd_h_niceng180er13.tab7_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_niceng180er13.tab7_1_1_1_4 hd_h_niceng180er13.tab7_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">Eleven patients in the non-ICU protocol were secondarily transferred to the ICU because of flap failure.</td><td headers="hd_h_niceng180er13.tab7_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not reported</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab8" class="table"><h3><span class="label">Table 8</span><span class="title">Evidence not suitable for GRADE analysis: ICU compared to surgical ward – high risk; elective & emergency surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab8/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab8_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><th id="hd_h_niceng180er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study (no. of participants)</th><th id="hd_h_niceng180er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng180er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgical ward results</th><th id="hd_h_niceng180er13.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICU results</th><th id="hd_h_niceng180er13.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><i>P</i> value</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab8_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of hospital stay (days)</td><td headers="hd_h_niceng180er13.tab8_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Curran 1998 (61)</td><td headers="hd_h_niceng180er13.tab8_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very high</td><td headers="hd_h_niceng180er13.tab8_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median (range): 17 (2–49)</td><td headers="hd_h_niceng180er13.tab8_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median (range): 21 (1–121)</td><td headers="hd_h_niceng180er13.tab8_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not reported</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab9" class="table"><h3><span class="label">Table 9</span><span class="title">Evidence not suitable for GRADE analysis: ICU compared to surgical ward – high risk; elective surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab9/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab9_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><th id="hd_h_niceng180er13.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study (no. of participants)</th><th id="hd_h_niceng180er13.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng180er13.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Surgical ward results</th><th id="hd_h_niceng180er13.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICU results</th><th id="hd_h_niceng180er13.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><i>P</i> value</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab9_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Length of hospital stay (days)</td><td headers="hd_h_niceng180er13.tab9_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Swart 2012 (90)</td><td headers="hd_h_niceng180er13.tab9_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_niceng180er13.tab9_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median (range): 13 (6–61)</td><td headers="hd_h_niceng180er13.tab9_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Median (range): 12 (5–41)</td><td headers="hd_h_niceng180er13.tab9_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">not reported</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab10" class="table"><h3><span class="label">Table 10</span><span class="title">Evidence not suitable for GRADE analysis: HDU compared to surgical ward – low/intermediate risk; elective surgery</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab10/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab10_lrgtbl__"><table><thead><tr><th id="hd_h_niceng180er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcome</th><th id="hd_h_niceng180er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study (no. of participants)</th><th id="hd_h_niceng180er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng180er13.tab10_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PACU results</th><th id="hd_h_niceng180er13.tab10_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">ICU results</th><th id="hd_h_niceng180er13.tab10_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><i>P</i> value</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab10_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unplanned intensive care unit admission/readmis sion</td><td headers="hd_h_niceng180er13.tab10_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Swart 2017 (207)</td><td headers="hd_h_niceng180er13.tab10_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High</td><td headers="hd_h_niceng180er13.tab10_1_1_1_4 hd_h_niceng180er13.tab10_1_1_1_5" colspan="2" rowspan="1" style="text-align:left;vertical-align:top;">22/139 patients in the non-HDU protocol were secondarily transferred to the HDU. The most common medical or non-surgical reason for unplanned critical care admission was pneumonia.</td><td headers="hd_h_niceng180er13.tab10_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">0.00015</td></tr></tbody></table></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab11" class="table"><h3><span class="label">Table 11</span><span class="title">Health economic evidence profile: Intensive care unit versus general ward</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab11/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab11_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng180er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng180er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng180er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng180er13.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_niceng180er13.tab11_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental QALYs</th><th id="hd_h_niceng180er13.tab11_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_niceng180er13.tab11_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab11_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Lindemark 2017<a class="bk_pop" href="#niceng180er13.ref7"><sup>7</sup></a></p>
|
||
<p>(Norway)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab11_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup><a class="bk_pop" href="#niceng180er13.tab11_1">(a)</a></sup></td><td headers="hd_h_niceng180er13.tab11_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious limitations<sup><a class="bk_pop" href="#niceng180er13.tab11_2">(b)</a></sup></td><td headers="hd_h_niceng180er13.tab11_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Population: General adult ICU population (acute surgery and planned surgery reported).</div></li><li class="half_rhythm"><div>Intervention 1: General ward</div></li><li class="half_rhythm"><div>Intervention 2: Intensive care unit</div></li><li class="half_rhythm"><div>Cost-utility analysis</div></li><li class="half_rhythm"><div>Probabilistic decision analytic model based on individuals from the Norwegian Intensive Care Registry.</div></li><li class="half_rhythm"><div>Lifetime horizon</div></li></ul></td><td headers="hd_h_niceng180er13.tab11_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<i>
|
||
<u>Acute surgery:</u>
|
||
</i>
|
||
</p>
|
||
<p>Incremental (2−1): £13,484</p>
|
||
<p>
|
||
<i>
|
||
<u>Planned surgery:</u>
|
||
</i>
|
||
</p>
|
||
<p>Incremental (2−1): £10,552</p>
|
||
</td><td headers="hd_h_niceng180er13.tab11_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<i>
|
||
<u>Acute surgery:</u>
|
||
</i>
|
||
</p>
|
||
<p>Incremental (2−1): 1.7</p>
|
||
<p>
|
||
<i>
|
||
<u>Planned surgery:</u>
|
||
</i>
|
||
</p>
|
||
<p>Incremental (2−1): 1.1</p>
|
||
</td><td headers="hd_h_niceng180er13.tab11_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<i>
|
||
<u>Acute surgery:</u>
|
||
</i>
|
||
</p>
|
||
<p>£7,932 per QALY gained</p>
|
||
<p>
|
||
<i>
|
||
<u>Planned surgery:</u>
|
||
</i>
|
||
</p>
|
||
<p>£8,794 per QALY gained</p>
|
||
</td><td headers="hd_h_niceng180er13.tab11_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Probabilistic sensitivity analysis was conducted by performing 1000 iterations.</p>
|
||
<p>Scenario analyses involved applying a constant ICU or general ward daily cost and another scenario involved accounting for lifetime health care costs beyond 5 years.</p>
|
||
</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">Abbreviations: ICER: incremental cost-effectiveness ratio; ICU: intensive care unit; QALY: quality-adjusted life years; RCT: randomised controlled trial</p></div></dd><dt>(a)</dt><dd><div id="niceng180er13.tab11_1"><p class="no_margin">Norwegian healthcare perspective and 2016 Norwegian Kroners may not be relevant to current UK practice. Health related quality of life was not obtained from patients and unclear what valuation method was used. Discount rate used is not in line with NICE reference case methods and cost of day in ICU and general ward was much higher compared to NHS.</p></div></dd><dt>(b)</dt><dd><div id="niceng180er13.tab11_2"><p class="no_margin">Baseline and treatment effects were not obtained from relevant RCT data but from registry data and SAPS 2 model. Unclear if complications were included in the model. Resource use and costs associated with general ward length of stay was based on assumptions.</p></div></dd><dt>(c)</dt><dd><div id="niceng180er13.tab11_3"><p class="no_margin">2016 Norwegian Kroner converted to UK pounds<a class="bk_pop" href="#niceng180er13.ref13"><sup>13</sup></a>. Cost components incorporated: Cost of day on ICU or general ward, including nurse and physician salary, overheads, medication and disposables.</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab12" class="table"><h3><span class="label">Table 12</span><span class="title">Health economic evidence profile: High dependency unit versus general ward</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab12/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab12_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng180er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Applicability</th><th id="hd_h_niceng180er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Limitations</th><th id="hd_h_niceng180er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Other comments</th><th id="hd_h_niceng180er13.tab12_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental cost</th><th id="hd_h_niceng180er13.tab12_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Incremental effects</th><th id="hd_h_niceng180er13.tab12_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost effectiveness</th><th id="hd_h_niceng180er13.tab12_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Uncertainty</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab12_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>Swart 2017<a class="bk_pop" href="#niceng180er13.ref17"><sup>17</sup></a></p>
|
||
<p>(UK)</p>
|
||
</td><td headers="hd_h_niceng180er13.tab12_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Partially applicable<sup><a class="bk_pop" href="#niceng180er13.tab12_1">(a)</a></sup></td><td headers="hd_h_niceng180er13.tab12_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Potentially serious limitations<sup><a class="bk_pop" href="#niceng180er13.tab12_2">(b)</a></sup></td><td headers="hd_h_niceng180er13.tab12_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<ul><li class="half_rhythm"><div>Population: People undergoing elective colorectal surgery with a 1–3% risk of 30 day mortality</div></li><li class="half_rhythm"><div>Intervention 1: General ward</div></li><li class="half_rhythm"><div>Intervention 2: High dependency unit</div></li><li class="half_rhythm"><div>Cost-consequences analysis (various health outcomes)</div></li><li class="half_rhythm"><div>Within-trial analysis of a non-randomised study (Swart 2017<a class="bk_pop" href="#niceng180er13.ref17"><sup>17</sup></a>)</div></li><li class="half_rhythm"><div>Follow-up: 30 days</div></li></ul></td><td headers="hd_h_niceng180er13.tab12_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">−£350<sup><a class="bk_pop" href="#niceng180er13.tab12_3">(c)</a></sup></td><td headers="hd_h_niceng180er13.tab12_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>
|
||
<b>Mortality:</b>
|
||
</p>
|
||
<p>RR 0.68 (CI: 0.07, 6.43); ARD −7 per 1000</p>
|
||
<p>
|
||
<b>Postoperative complication - emergency laparotomy:</b>
|
||
</p>
|
||
<p>Peto OR 0.2 (CI: 0.06, 0.65); ARD −79 per 1000</p>
|
||
</td><td headers="hd_h_niceng180er13.tab12_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intervention 2 was cost-saving, and led to lower mortality and complications.</td><td headers="hd_h_niceng180er13.tab12_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">Abbreviations: ARD = absolute risk difference; OR = odds ratio; RR = risk ratio</p></div></dd><dt>(a)</dt><dd><div id="niceng180er13.tab12_1"><p class="no_margin">UK NHS perspective and costs from 2013 may not reflect current practice. Measure of effect is not in line with NICE reference case methods as the analysis does not report QALYs.</p></div></dd><dt>(b)</dt><dd><div id="niceng180er13.tab12_2"><p class="no_margin">Baseline and treatment effects were based on a single cohort study conducted at one hospital England; analysis may not fully capture all outcomes as overall complications were not reported. Source of unit costs based on the payment by results tariff which may understate actual costs incurred by the NHS.</p></div></dd><dt>(c)</dt><dd><div id="niceng180er13.tab12_3"><p class="no_margin">2013 UK pounds. Cost components incorporated: Cost of ward bed day, HDU bed day and ICU bed day</p></div></dd></dl></div></div></div></div><div class="whole_rhythm bk_prnt_obj"><div id="niceng180er13.tab13" class="table"><h3><span class="label">Table 13</span><span class="title">UK costs of hospital stay</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK561964/table/niceng180er13.tab13/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng180er13.tab13_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng180er13.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Ward</th><th id="hd_h_niceng180er13.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Cost<sup><a class="bk_pop" href="#niceng180er13.tab13_1">(a)</a></sup></th><th id="hd_h_niceng180er13.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Average length of stay<sup><a class="bk_pop" href="#niceng180er13.tab13_2">(b)</a></sup></th><th id="hd_h_niceng180er13.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">HRG Code, description</th></tr></thead><tbody><tr><td headers="hd_h_niceng180er13.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Intensive care unit (cost per day)</td><td headers="hd_h_niceng180er13.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,384</td><td headers="hd_h_niceng180er13.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.95</td><td headers="hd_h_niceng180er13.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>CCU02, CCU06 and CCU08</p>
|
||
<p>Surgical adult patients (unspecified specialty), Cardiac surgical adult patients predominate and Thoracic surgical adult patients predominate with 1 or more organs supported</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">High dependency unit (cost per day)</td><td headers="hd_h_niceng180er13.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£707</td><td headers="hd_h_niceng180er13.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">3.95</td><td headers="hd_h_niceng180er13.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
||
<p>CCU02, CCU06 and CCU08</p>
|
||
<p>Surgical adult patients (unspecified specialty), Cardiac surgical adult patients predominate and Thoracic surgical adult patients predominate with 0 organs supported</p>
|
||
</td></tr><tr><td headers="hd_h_niceng180er13.tab13_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">General ward bed day</td><td headers="hd_h_niceng180er13.tab13_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£407</td><td headers="hd_h_niceng180er13.tab13_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">n/a</td><td headers="hd_h_niceng180er13.tab13_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Based on elective inpatient excess bed days, all episodes excluding paediatrics</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt>(a)</dt><dd><div id="niceng180er13.tab13_1"><p class="no_margin">NHS Reference Costs 2017/18<a class="bk_pop" href="#niceng180er13.ref6"><sup>6</sup></a>, weighted average calculated</p></div></dd><dt>(b)</dt><dd><div id="niceng180er13.tab13_2"><p class="no_margin">Hospital episode statistics 2016<a class="bk_pop" href="#niceng180er13.ref12"><sup>12</sup></a>, weighted average calculated</p></div></dd></dl></div></div></div></div></div><div><p>Final</p></div><div><p>Evidence reviews underpinning recommendation 1.5.1 and the research recommendation in the NICE guideline</p><p>This evidence review was developed by the National Guideline Centre</p></div><div><p><b>Disclaimer:</b> The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and, where appropriate, their carer or guardian.</p><p>Local commissioners and providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a>, <a href="http://www.scotland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Scottish Government</a>, and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. All NICE guidance is subject to regular review and may be updated or withdrawn.</p></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © NICE 2020.</div><div class="small"><span class="label">Bookshelf ID: NBK561964</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/32931168" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">32931168</a></span></div></div></div>
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