Need for critical care in gynaecology: a population-based analysis

The purpose of this study was to note potential gynaecological risk factors leading to intensive care and to estimate the frequency, costs and outcome of management.

In a cross-sectional study of intensive care admissions in Kuopio from March 1993 to December 2000, 23 consecutive gynaecological patients admitted to a mixed medical-surgical intensive care unit (ICU) were followed. We recorded demographics, admitting diagnoses, scores on the Acute Physiological and Chronic Health Evaluation (APACHE) II, clinical outcome and treatment costs.

The overall need for intensive care was 2.3 per 1000 women undergoing major surgery during the study period. Patients were 55.4 +/- 16.9 (mean +/- SD) years old, with a mean APACHE II score of 14.07 (+/- 5.57). The most common diagnoses at admission were postoperative haemorrhage (43%), infection (39%) and cardiovascular disease (30%). The duration of stay in the ICU was 4.97 (+/- 9.28) (range 1-42) days and the mortality within 6 months was 26%, although the mortality in the ICU was 0%. The total cost of intensive care was approximately 7044 US dollars per patient.

Very few gynaecological patients develop complications requiring intensive care. The presence of gynaecological malignancy and pre-existing medical disorders are clinically useful predictors of eventual outcome, but many cases occur in women with a low risk and this implies that the risk is relevant to all procedures. Further research is needed to determine effective preventive approaches.