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



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.


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.


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.


We did not identify any survival benefit from critical care admission following surgery.


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



This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London. ISOS investigators were entirely responsible for study design, conduct, and data analysis. The authors had full data access and were solely responsible for data interpretation, drafting and critical revision of the manuscript, and the decision to submit for publication.

Data sharing

The authors are happy to consider data sharing requests from bona fide researchers. Participant consent was not obtained but the presented data are anonymised and risk of identification is low. Enquiries should be addressed to the chief investigator at

Compliance with ethical standards

Conflicts of interest

RP holds research grants and has given lectures and/or performed consultancy work for Nestle Health Sciences, BBraun, Medtronic, and Edwards Lifesciences, and is a member of the Associate Editorial Board of the British Journal of Anaesthesia. All other authors declare they have no conflicts of interest.

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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