Outcome of noncardiac surgical patients admitted to a multidisciplinary intensive care unit

Abstract

Context:Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU).Aims:We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU.Settings and Design:This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months.Subjects and Methods:Data on demography, admission Acute Physiology and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA) scores, perioperative course, type and duration of surgery, reason for ICU admission, ICU interventions, and perioperative complications were recorded. The primary outcomes analyzed were perioperative complications and mortality.Results:The study included 762 patients with a mean age of (mean ± standard deviation [SD]) 50.5 ± 18 years and a male (58.4%) preponderance. The mean (±SD) admission APACHE-II and SOFA scores were 15 (±5.0) and 4.26 (±2.6), respectively. The most common reason for ICU admission was elective mechanical ventilation 50%, followed by prolonged surgery 26.2% and hemodynamic instability 21.2%. Most (51.1%) patients belonged to American Society of Anaesthesiologists physical Status III or IV and Lee's surgical risk Category I and II (66.8%). The most common surgical procedures performed were gastro-intestinal (28.5%) followed by interventional Neuro-radiology (14.0%) and orthopedic (13.9%). Overall perioperative complications were observed in 51.4% (n = 392). Common complications observed were hemodynamic instability 24%, hypothermia 17.2%, sepsis 17.3%, poor glycemic control 11.2%, perioperative myocardial infarction 7.1%, cardiac arrest 0.13%, and acute kidney injury (AKI) 10.1%. The overall hospital mortality was 7.9%. Multivariate logistic regression analysis showed that admission APACHE-II score, sepsis, AKI, and ICU length of stay were independent predictors for mortality.Conclusions:High risk perioperative patients after noncardiac surgery have significant mortality and morbidity.

COVID-19 Infection Post-Laparoscopic Sleeve Gastrectomy: A Case Report and Review of Literature

“…46.7% of the ICU group died versus 20.6% of the control. Mortality was higher than the reported overall case-fatality rate of non-surgical COVID-19 patients (2.3%) and that of COVID-19-free non-cardiac surgical patients who were admitted to the ICU (7.9%) [9,10].…”

Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection

“…This mortality rate is much higher than the reported overall case-fatality rate of 2¢3% in COVID-19 patients without surgery, [9] and also higher than the case-fatality rate of 7¢9% in noncardiac surgical patients without COVID-19 infection who were admitted to multidisciplinary ICU. [20] Furthermore, the average duration from the time of first symptom to death of the 7 non-survivors (8¢7 days, range 4 to 13 days) is apparently shorter than that reported previously. In the report of Huang and colleagues, [5] the median time from onset of symptoms to first hospital admission was 7.0 days (4.0À8.0) and to ICU admission was 10.5 days (8.0À17.0) and 6 patients (15% of the total of 41 cases studied) did not survive ICU.…”

COVID-19 infection, a potential threat to surgical patients and staff? A retrospective cohort study

“…Surgical patients with COVID-19 showed significantly increased complications compared with patients infected with COVID-19 without surgery, especially in terms of ARDS (23.53%), shock (17.65%), secondary infection (5 [29.41%]), arrhythmia (3 [17.65%]), and acute cardiac injury (2 [11.76%]), and complication incidence rates were also higher compared with surgical patients without COVID-19 infection [ 16 ]. Although the SAPS Ⅱ scores in surgical patients with COVID-19 were not higher than that in normal surgical patients [ 17 ], two surgical patients (11.76%) died of COVID-19-associated complications, which was much higher than the reported overall case-fatality rate of 4.3% in COVID-19 patients without surgery [ 3 ] and was also higher than the case-fatality rate of 7.9% in noncardiac surgical patients [ 16 ].…”