TY - JOUR
T1 - Critical care admission following elective surgery was not associated with survival benefit
T2 - prospective analysis of data from 27 countries
AU - The International Surgical Outcomes Study (ISOS) group
AU - Kahan, Brennan C.
AU - Koulenti, Desponia
AU - Arvaniti, Kostoula
AU - Beavis, Vanessa
AU - Campbell, Douglas
AU - Chan, Matthew
AU - Moreno, Rui
AU - Pearse, Rupert M.
AU - Pearse, Rupert M.
AU - Beattie, Scott
AU - Clavien, Pierre Alain
AU - Demartines, Nicolas
AU - Fleisher, Lee A.
AU - Grocott, Mike
AU - Haddow, James
AU - Hoeft, Andreas
AU - Holt, Peter
AU - Moreno, Rui
AU - Pritchard, Naomi
AU - Rhodes, Andrew
AU - Wijeysundera, Duminda
AU - Wilson, Matt
AU - Ahmed, Tahania
AU - Everingham, Kirsty
AU - Hewson, Russell
AU - Januszewska, Marta
AU - Pearse, Rupert M.
AU - Phull, Mandeep Kaur
AU - Halliwell, Richard
AU - Shulman, Mark
AU - Myles, Paul
AU - Schmid, Werner
AU - Hiesmayr, Michael
AU - Wouters, Patrick
AU - De Hert, Stefan
AU - Lobo, Suzana
AU - Beattie, Scott
AU - Wijeysundera, Duminda
AU - Fang, Xiangming
AU - Rasmussen, Lars
AU - Futier, Emmanuel
AU - Biais, Matthieu
AU - Venara, Aurélien
AU - Slim, Karem
AU - Sander, Michael
AU - Koulenti, Despoina
AU - Arvaniti, Kostoula
AU - Weimann, Joerg
AU - Tolenaar, Noortje
AU - Boer, Christa
AU - AUTHOR GROUP
AU - Chan, Mathew
AU - Kulkarni, Atul
AU - Chandra, Susilo
AU - Tantri, Aida
AU - Geddoa, Emad
AU - Chen, Sijia
AU - Hollmann, Markus
AU - Hulst, Abraham
AU - Preckel, Benedikt
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.
AB - Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.
KW - Critical care/utilisation
KW - Postoperative care/methods
KW - Postoperative care/statistics and numerical data
KW - Surgical procedures, operative/mortality
UR - http://www.scopus.com/inward/record.url?scp=85018845020&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00134-016-4633-8
DO - https://doi.org/10.1007/s00134-016-4633-8
M3 - Article
C2 - 28439646
SN - 0342-4642
VL - 43
SP - 971
EP - 979
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 7
ER -