Intensive Care Medicine

, Volume 43, Issue 7, pp 971–979 | Cite as

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

  • Brennan C. Kahan
  • Desponia Koulenti
  • Kostoula Arvaniti
  • Vanessa Beavis
  • Douglas Campbell
  • Matthew Chan
  • Rui Moreno
  • Rupert M. Pearse
  • The International Surgical Outcomes Study (ISOS) group
Original

Abstract

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.

Keywords

Postoperative care/methods Postoperative care/statistics and numerical data Surgical procedures, operative/mortality Critical care/utilisation 

Supplementary material

134_2016_4633_MOESM1_ESM.docx (629 kb)
Supplementary material 1 (DOCX 630 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2017

Authors and Affiliations

  • Brennan C. Kahan
    • 1
  • Desponia Koulenti
    • 2
    • 3
  • Kostoula Arvaniti
    • 4
  • Vanessa Beavis
    • 5
  • Douglas Campbell
    • 5
  • Matthew Chan
    • 6
  • Rui Moreno
    • 7
  • Rupert M. Pearse
    • 8
    • 9
  • The International Surgical Outcomes Study (ISOS) group
  1. 1.Queen Mary University of LondonLondonUK
  2. 2.Attikon University HospitalAthensGreece
  3. 3.University of QueenslandBrisbaneAustralia
  4. 4.Papageorgiou General HospitalThessalonikiGreece
  5. 5.Auckland City HospitalAucklandNew Zealand
  6. 6.Chinese University of Hong KongSha TinHong Kong
  7. 7.Hospital de São José, Centro Hospitalar de Lisboa Central, LisboaLisbonPortugal
  8. 8.Queen Mary University of LondonLondonUK
  9. 9.Adult Critical Care UnitRoyal London HospitalLondonUK

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