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Routine Intensive Care Unit Admission Following Liver Resection: What Is the Value Proposition?

Journal of Gastrointestinal Surgery volume 24, pages 2491–2499 (2020)Cite this article

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Abstract

Introduction

The value of routine ICU admission after elective surgery has been debated due to the lack of robust evidence supporting its benefit, as well as the increased incurred costs. We sought to analyze outcomes of patients undergoing hepatectomy who were routinely admitted to the intensive care unit (ICU) compared with surgical ward admission.

Methods

Patients were identified in the Truven Health Analytics MarketScan Commercial Claims and Encounters Database from 2010 to 2016. Routine postoperative ICU admission was defined as ICU admission for ≤ 24 h on postoperative day 0. Potential association between routine ICU admission with extended length-of-stay (LOS), failure-to-rescue, and total inpatient costs was analyzed.

Results

In total 7970 patients underwent hepatectomy; 37.7% (n = 3001) had routine ICU admission and 62.3% (n = 4969) surgical ward admission. Among the 3001 patients who had routine ICU admission, 1137 (37.9%) had a major and 1864 (62.1%) had a minor hepatectomy. Routine ICU admission was not associated with lower failure-to-rescue (routine ICU 4.9% vs. ward 1.8%; p < 0.001). Patients routinely admitted to the ICU had longer median LOS (routine ICU 7 days, IQR 5–15 days vs. ward 5 days, IQR 4–7 days; p < 0.001). Median payments were higher for routine ICU admission than for surgical ward admission ($50,501, IQR $34,270–$80,459 vs. $39,774, IQR $28,555–$58,270, respectively).

Conclusion

Routine ICU admission was associated with longer LOS and higher hospital payments, yet did not translate into lower failure-to-rescue among patients undergoing hepatectomy.

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Authors and Affiliations

  1. Department of Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite, Columbus, OH, 670, USA

    Katiuscha Merath, Ayesha Farooq, Diamantis I. Tsilimigras, Rittal Mehta, Anghela Z. Paredes, Kota Sahara, Mary Dillhoff, Allan Tsung, Jordan Cloyd, Aslam Ejaz & Timothy M. Pawlik

  2. Department of Surgery, Duke University, Durham, NC, USA

    Marcelo Cerullo

  3. Department of Surgery, Johns Hopkins University, Baltimore, MD, USA

    Joseph K. Canner & Jen He

Authors
  1. Katiuscha Merath
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  2. Marcelo Cerullo
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  3. Ayesha Farooq
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  4. Joseph K. Canner
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  5. Jen He
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  6. Diamantis I. Tsilimigras
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  7. Rittal Mehta
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  8. Anghela Z. Paredes
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  9. Kota Sahara
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  10. Mary Dillhoff
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  11. Allan Tsung
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  12. Jordan Cloyd
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  13. Aslam Ejaz
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  14. Timothy M. Pawlik
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Corresponding author

Correspondence to Timothy M. Pawlik.

Ethics declarations

All patient data were de-identified and compliant with the Health Insurance Portability and Accountability Act of 1996. Patient consent was therefore waived; the study was approved by the Johns Hopkins University Institutional Review Board (Baltimore, MD).

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The authors declare that they have no conflict of interest.

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Merath, K., Cerullo, M., Farooq, A. et al. Routine Intensive Care Unit Admission Following Liver Resection: What Is the Value Proposition?. J Gastrointest Surg 24, 2491–2499 (2020). https://doi.org/10.1007/s11605-019-04408-5

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  • DOI: https://doi.org/10.1007/s11605-019-04408-5

Keywords

  • Mortality
  • Failure-to-rescue
  • Hepatectomy
  • Intensive care unit