Post‐operative intensive care unit admission after elective non‐cardiac surgery: A single‐center analysis of the NSQIP database

Bruceta, Melanio; Souza, Luisa De; Carr, Zyad J.; Bonavia, Anthony; Kunselman, Allen R.; Karamchandani, Kunal

doi:10.1111/aas.13504

Cited by 9 publications

(9 citation statements)

References 32 publications

(34 reference statements)

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“…It is eligible to identify risk factors for unplanned ICU admission to improve patient safety and outcome. Previous studies have indicated several predictive factors for postoperative unplanned ICU admission such as higher ASA-PS, advanced age, elevated BMI, and prolonged surgical procedure [ 1 , 13 , 14 ]. However, we could not identify either a difference in patient characteristics between the groups or a specific factor related to unplanned ICU admission in this study.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

et al. 2022

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Background Unplanned ICU admission after surgery has been validated as a measure of a quality indicator of perioperative management because it may put surgical patients at risk of increased morbidity and mortality. Postoperative unscheduled admission to the ICU is usually determined either in the post-anesthesia care unit (PACU) or in the general surgical ward; however, it could be expected patient outcomes after ICU admission would be affected by the circumstances. The purpose of this retrospective observational study was to investigate the clinical characteristics and the outcome of unplanned admission to the ICU directly from the PACU or from the ward within 7 days after PACU discharge. Methods Forty-three thousand, five hundred fifty-three patients admitted to the PACU after general anesthesia were included in the study. Unplanned ICU admission was defined as the admission which was not anticipated preoperatively but was due to adverse events in the PACU (PACU group) or the ward after discharge from the PACU (Ward group). The following parameters were compared between the groups: patient characteristics, surgical characteristics, length of ICU and hospital stay, the principal adverse event for ICU admission, treatments in the ICU, and in-hospital mortality. The primary outcome was in-hospital mortality and the second was the length of ICU and hospital stay. Results Among 43,553 patients, 109 patients underwent unplanned ICU admission directly from the PACU (n= 73, 0.17%) or subsequently from the ward (n= 36, 0.08%). The length of both ICU and hospital stay was significantly longer in the Ward group than in the PACU group (1.4 and 19 days vs. 2.5 and 39 days, respectively). There was no significant difference in in-hospital mortality between the groups (4.1% vs. 8.3%, respectively). Conclusions The incidence of unplanned ICU admission after PACU stay was low, however, delayed admission to the ICU from the ward may prolong the length of both ICU and hospital stay compared to those directly from the PACU.

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Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

et al. 2022

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“…In retrospective analysis, patients with congestive heart failure, chronic kidney disease, peripheral vascular diseases, vascular diseases or higher BMI (i.e. BMI > 30) are found to be associated with unexpected postoperative ICU admission 29,30 . Some procedure-specific risk factors are also linked to unplanned ICU admission, for example, revision surgery for total hip arthroplasty or total knee arthroplasty 31 .…”

Section: Discussionmentioning

confidence: 99%

Surgical Apgar score is strongly associated with postoperative ICU admission

Lin

Chen

Yang

et al. 2021

Sci Rep

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Immediate postoperative intensive care unit (ICU) admission can increase the survival rate in patients undergoing high-risk surgeries. Nevertheless, less than 15% of such patients are immediately admitted to the ICU due to no reliable criteria for admission. The surgical Apgar score (SAS) (0–10) can be used to predict postoperative complications, mortality rates, and ICU admission after high-risk intra-abdominal surgery. Our study was performed to determine the relationship between the SAS and postoperative ICU transfer after all surgeries. All patients undergoing operative anesthesia were retrospectively enrolled. Among 13,139 patients, 68.4% and < 9% of whom had a SASs of 7–10 and 0–4. Patients transferred to the ICU immediately after surgery was 7.8%. Age, sex, American Society of Anesthesiologists (ASA) class, emergency surgery, and the SAS were associated with ICU admission. The odds ratios for ICU admission in patients with SASs of 0–2, 3–4, and 5–6 were 5.2, 2.26, and 1.73, respectively (P < 0.001). In general, a higher ASA classification and a lower SAS were associated with higher rates of postoperative ICU admission after all surgeries. Although the SAS is calculated intraoperatively, it is a powerful tool for clinical decision-making regarding the immediate postoperative ICU transfer.

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“…We applied the statistical approach previously described by Bruceta et al (8) Speci cally, the descriptive data are reported as frequencies and percentages for categorical variables and as means and standard deviations (SD) for continuous variables. Furthermore, continuous variables were assessed for normality by examining normal probability plots.…”

Section: Discussionmentioning

confidence: 99%

“…After approval by the Penn State College of Medicine Institutional Review Board (Study no: 7024, approval date: 03/28/2017), information on all elective non-cardiac surgical cases was obtained from the ACS NSQIP Ò database for the Penn State Milton S. Hershey Medical Center, from January 2011 through September 2016. We used the methodology previously described by Bruceta et al (8) The ACS NSQIP Ò obtains its data from randomly assigned patients by rigorously trained and audited data abstractors. The database records hospital-reported preoperative and post-surgical outcomes for 30 days (4).…”

Section: Data Sourcementioning

confidence: 99%

Analysis of the American College of Surgeons National Surgical Quality Improvement ProgramÒ (ACS NSQIPÒ) database to identify factors associated with postoperative mortality after elective non-cardiac surgery

Malviya

Bruceta

Singh

et al. 2021

Preprint

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Background: Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement ProgramÒ (ACS NSQIPÒ) risk calculator have been devised to predict post-operative mortality. However, the role of individual factors on mortality is unclear. We sought to identify patient characteristics from the database that were associated with postoperative mortality in patients undergoing elective, non-cardiac surgery. Methods: Data from the ACS NSQIPÒ database at a tertiary care academic medical center was analyzed from January 2011 to September 2016. Relevant patient related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality. A multivariable logistic regression model was then used to assess the adjusted effect of each potential risk factor on the outcome. Results: 5,254 database patient records were identified and among the analyzed variables, American Society of Anesthesiologists (ASA) physical status III and IV (odds ratio and 95%CI : 16.75 [2.29, 122.69] ), poor preoperative functional health status (Odds ratio and 95%CI : 38.52 [2.46, 604.12] ), and low serum albumin (Odds ratio and 95%CI : 3.76 [1.35, 10.44]) were significant predictors of 30-day postoperative mortality.Conclusions: In a comprehensive analysis of the ACS NSQIPÒdatabase, spreading across multiple surgical specialties, we found an association between ASA physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery.

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Post‐operative intensive care unit admission after elective non‐cardiac surgery: A single‐center analysis of the NSQIP database

Cited by 9 publications

References 32 publications

Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

Surgical Apgar score is strongly associated with postoperative ICU admission

Analysis of the American College of Surgeons National Surgical Quality Improvement ProgramÒ (ACS NSQIPÒ) database to identify factors associated with postoperative mortality after elective non-cardiac surgery

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