Intensive care utilisation and outcomes after high-risk surgery in Scotland: a population based cohort study.

M.A. Gillies, E.M. Harrison, R. M. Pearse, Sweyn Garrioch, C. Haddow, Lorraine Smyth, R Parks, T.S. Walsh, N.I. Lone

Research output: Contribution to journalArticlepeer-review

Abstract

The optimum perioperative use of Intensive Care Unit (ICU) resources is not yet defined. We sought determine the effect of ICU admission on perioperative (30-day) and long term mortality. Methods: Observational study of all surgical cases in Scotland 2005-2007 followed-up until 2012. Patient, operative and care process factors were extracted. Primary outcome was perioperative mortality; secondary outcomes one and four-year mortality. Multivariable regression was used to construct a risk prediction model to allow standard-risk and high-risk groups to be defined based on deciles of predicted perioperative mortality risk, and to determine the effect of ICU admission (direct from theatre; indirect after initial care on ward; no ICU admission) on outcome adjusted for confounders. Results: 572598 patients were included. The risk model performed well (c-index 0.922). Perioperative mortality was 1125 (0.2%) in the standard-risk group (n=510979) and 3636 (6.4%) in the high-risk group (n=56785). Patients with no ICU admission within 7-days of surgery had the lowest perioperative mortality (whole cohort 0.7%; high-risk cohort 5.3%). Indirect ICU admission was associated with a higher risk of perioperative mortality when compared to direct admission for the whole cohort (20.9% vs 12.1%; adjusted OR 2.39, 95%CI 2.01, 2.84; p<0.01) and for high-risk patients (26.2% vs 17.8%; adjusted OR 1.64, 95%CI 1.37, 1.96; p<0.01). Compared with direct ICU admission, indirectly admitted patients had higher severity of illness on admission, required more organ support and had an increased duration of ICU stay. Conclusion: Indirect ICU admission was associated with increased mortality and increased requirement for organ support.
Original languageEnglish
JournalBritish Journal of Anaesthesia
Volume118
Issue number1
Early online date13 Dec 2017
DOIs
Publication statusE-pub ahead of print - 13 Dec 2017

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