Do we really need postoperative ICU management after elective surgery? No, not any more!

Cancelled operations: a 7-day cohort study of planned adult inpatient surgery in 245 UK National Health Service hospitals

“…46,47 Recent large-scale studies also raise the issue of whether critical care is of benefit to all patients, or whether in fact some may be harmed by inappropriate interventions. 48,49 Research is needed into which patients would benefit most from critical care so as to make best use of this limited resource. Although there are ethical and practical challenges around conducting randomised trials in this area, 46,48,50 novel statistical techniques designed for inferring causation in observational studies may provide a solutiondto that end, the main analysis of the SNAP-2: EPICCS study will attempt to address this question.…”

The association between ICU admission and emergency hospital readmission following emergency general surgery

“…However, some studies and commentators have suggested routine ICU admission after certain elective major surgical procedures may increase costs and LOS without improvement in survival. 11,12,27,28 As yet few studies have examined patterns of ICU use on post discharge complications or emergency hospital readmission (the rates of which are much higher than death) or longer term costs following surgery.…”

Improving the care for elective surgical patients: post-operative ICU admission and outcome

“…In addition, the improvement of surgical and anaesthetic techniques has been associated with a reduction of perioperative physiological derangements, which may allow, in selected cases, a proper post-operative monitoring in standard wards, under the supervision of adequately trained medical staff. Hence, as recently proposed by Taccone et al (12), a postoperative "intermediate care" ward may represent a future pathway of equipoise between clinical safety and limited costs.…”