Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

Kahan, Brennan C., Koulenti, Desponia, Arvaniti, Kostoula, Beavis, Vanessa, Campbell, Douglas, Chan, Matthew, Moreno, Rui, Pearse, Rupert M. and The International Surgical Outcomes Study (ISOS) group (2017) Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Medicine, 43 7: 971-979. doi:10.1007/s00134-016-4633-8


Author Kahan, Brennan C.
Koulenti, Desponia
Arvaniti, Kostoula
Beavis, Vanessa
Campbell, Douglas
Chan, Matthew
Moreno, Rui
Pearse, Rupert M.
The International Surgical Outcomes Study (ISOS) group
Title Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries
Journal name Intensive Care Medicine   Check publisher's open access policy
ISSN 1432-1238
0342-4642
Publication date 2017-07-01
Year available 2017
Sub-type Article (original research)
DOI 10.1007/s00134-016-4633-8
Open Access Status Not yet assessed
Volume 43
Issue 7
Start page 971
End page 979
Total pages 9
Place of publication Heidelberg, Germany
Publisher Springer
Language eng
Subject 2706 Critical Care and Intensive Care Medicine
Abstract Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.
Formatted abstract
Purpose

As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality.

Methods

Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests.

Results

44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings.

Conclusions

We did not identify any survival benefit from critical care admission following surgery.
Keyword Postoperative care/methods
Postoperative care/statistics and numerical data
Surgical procedures, operative/mortality
Critical care/utilisation
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID RP_2014-04-022
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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