Intensive care after vascular surgery: systematic review.

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Health Services Research

Background:

• The optimal utilization of intensive care unit (ICU) resources for patients undergoing vascular surgery remains an area of uncertainty.
• Evaluating the impact of ICU admission on clinical outcomes and associated costs is crucial for informed decision-making.

Purpose of the Study:

• To systematically review and evaluate the impact of intensive care unit (ICU) admission on clinical outcomes and costs following elective and emergency vascular surgery.

Main Methods:

• A comprehensive literature search was conducted across major databases including MEDLINE, Embase, and the Cochrane Library in July 2024.
• Included studies compared intensive care unit (ICU) care with intermediary or ward-based care for patients undergoing major vascular surgery.

Main Results:

• Thirteen studies involving 157,932 patients were analyzed. ICU admission was associated with significantly higher adjusted 30-day or in-hospital mortality (OR 4.14).
• Unadjusted analyses indicated increased risks of major adverse cardiovascular events, acute kidney injury, need for dialysis, readmission, and major bleeding in patients admitted to ICU.
• Higher rates of respiratory failure requiring mechanical ventilation and infection were observed in the ICU group, alongside increased hospital-associated costs.

Conclusions:

• No definitive clinical benefit was identified for intensive care unit (ICU) admission post-vascular surgery.
• Potential reasons for the observed outcomes include residual confounding factors and inadequate risk stratification in patient selection.