Admission to the surgical intensive care unit during intensivist coverage is associated with lower incidence of postoperative acute kidney injury and shorter ventilator time
- 38 Downloads
This study aimed to assess the impact of intensivist coverage on the incidence of acute kidney injury (AKI) and ventilator time among patients postoperatively admitted to the intensive care unit (ICU).
Adult patients postoperatively admitted to the ICU between January 2012 and December 2017 were retrospectively enrolled. The incidence of AKI within 72 h of surgery and the postoperative ventilator time were compared between the groups covered by intensivists and non-intensivists.
After propensity score (PS) matching, 5650 patients were included in the final analysis (2825 patients in each group). The incidence rate of AKI was significantly higher in the non-intensivist coverage group than in the intensivist coverage group (22.7% vs. 20.2%; P = 0.023). Moreover, logistic regression analysis in the PS-matched cohort showed that the incidence of postoperative AKI in the non-intensivist coverage group increased by 16% compared to that in the intensivist coverage group (odds ratio 1.16, 95% confidence interval 1.02–1.32; P = 0.023). Additionally, the median time of ventilator use in the non-intensivist coverage group was significantly longer than that in the intensivist coverage group [7.8 (interquartile range, IQR 2.6–13.8) h vs. 5.3 (1.8–8.3) h; P < 0.001].
High-intensity intensivist coverage is associated with a lower risk of postoperative AKI and shorter postoperative ventilator times. These findings suggested that in addition to medical trainees, initial management of surgical ICU patients by intensivists may lower the risk of AKI and facilitate early weaning from mechanical ventilation.
KeywordsAcute kidney injury Critical illness Intensive care units Ventilators Mechanical
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
- 4.Kerlin MP, Adhikari NK, Rose L, Wilcox ME, Bellamy CJ, Costa DK, Gershengorn HB, Halpern SD, Kahn JM, Lane-Fall MB, Wallace DJ, Weiss CH, Wunsch H, Cooke CR, ATS Ad Hoc Committee on ICU Organization. An Official American Thoracic Society systematic review: the effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients. Am J Respir Crit Care Med. 2017;195(3):383–93.PubMedGoogle Scholar
- 9.Tak Kyu O, Ji E, Ahn S, Kim DJ, Song IA. Admission to surgical intensive care unit in time with intensivist coverage and its association with postoperative 30-day mortality: the role of intensivists in a surgical intensive care unit. Anaesth Crit Care Pain Med. 2019;38(3):259–63.PubMedCrossRefGoogle Scholar
- 21.Grissinger M. An exhausted workforce increases the risk of errors. Pharm Ther. 2009;34(3):120–3.Google Scholar