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

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.