Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study
M A Gillies1, E M Harrison2, R M Pearse3
1Department of Anaesthesia, Critical Care and Pain Medicine michael.gillies@ed.ac.uk.
British Journal of Anaesthesia
|January 1, 2017
Summary
Indirect intensive care unit (ICU) admission after surgery is linked to higher mortality. Patients admitted indirectly had greater illness severity and required more organ support compared to direct ICU admissions.
Area of Science:
- Critical Care Medicine
- Surgical Outcomes
- Health Services Research
Background:
- Optimal utilization of intensive care unit (ICU) resources remains undefined.
- The impact of ICU admission on perioperative and long-term mortality requires further investigation.
Purpose of the Study:
- To determine the effect of ICU admission strategies on perioperative and long-term mortality.
- To analyze the association between direct vs. indirect ICU admission and patient outcomes.
Main Methods:
- Observational study of surgical patients in Scotland (2005-2012).
- Development of a risk prediction model for perioperative mortality.
- Multivariable regression analysis to adjust for confounders and assess ICU admission effects.
Main Results:
- Indirect ICU admission was associated with significantly higher perioperative mortality (adjusted OR 2.39) compared to direct admission.
- Indirectly admitted patients exhibited higher illness severity, increased need for organ support, and longer ICU stays.
- No ICU admission was associated with the lowest perioperative mortality across the cohort.
Conclusions:
- Indirect ICU admission is linked to increased mortality and greater need for organ support.
- The findings highlight potential disparities in care pathways and outcomes based on ICU admission timing.
