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Critical care unit bed availability and postoperative outcomes: a multinational cohort study.

Ruaraidh A S Campbell1, Tharusan Thevathasan2, Danny J N Wong3,4

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Anaesthesia
|September 26, 2024
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Postoperative critical care admission decisions vary and depend on bed availability, not patient risk. Advanced statistical analysis suggests no difference in patient outcomes based on admission, warranting further trials.

Keywords:
critical careinstrumental variableperi‐operative care

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Area of Science:

  • Critical care medicine
  • Health services research
  • Surgical outcomes

Background:

  • Critical care beds are a limited resource, with recommendations for postoperative admission often not followed.
  • Real-world prioritization decisions for critical care and their impact on patient outcomes remain unclear.

Purpose of the Study:

  • To investigate the factors influencing postoperative critical care admission decisions.
  • To evaluate the effect of critical care admission on postoperative morbidity using advanced statistical methods.

Main Methods:

  • Observational cohort study of 19,491 adult surgical patients across 248 UK and Australasian hospitals in 2017.
  • Logistic regression and instrumental variable analysis using critical care bed occupancy variation to estimate causal effects.
  • Primary outcome: postoperative morbidity at day 7.

Main Results:

  • Postoperative critical care admission was associated with surgical risk and critical care bed availability (OR 1.04 per bed).
  • Significant variation in admission probability between hospitals (median OR 3.05).
  • No evidence of a difference in postoperative morbidity with critical care admission (OR 0.91).

Conclusions:

  • Postoperative critical care admission is variable and influenced by bed availability.
  • Statistical adjustments for confounding suggest reduced estimates of harm from critical care admission.
  • Findings support a clinical trial to assess potential benefits of critical care admission for select patients.