Surgical Patients Admitted to Intensive Care: Do Elective and Urgent Surgical Patients Have Similar Outcomes?

The landscape of critical care is evolving. Advances in treatment and supportive care, along with the evolving technology supporting surgical interventions, such as robotics, have made it possible to achieve outstanding results. Contemporary evaluation of prognosis in critically ill surgical patients is paramount to support individualized care and informed decision-making. This study aimed to assess and compare short-term (first 30 days) and long-term (up to two years) outcomes of elective versus urgent surgical patients admitted to the intensive care unit (ICU) and to characterize their clinical trajectory patterns beyond the traditional grouping of "surgical patients."

We performed a post hoc analysis of the Critically Ill patients' mortality by age: Long-Term follow-up (CIMbA-LT) study, a retrospective, multicenter, observational study conducted on Portuguese multipurpose ICUs over four years. Surgical patients were segregated for further analysis. We compared differences between patients admitted after elective or urgent surgery.

We included 13,748 surgical adult patients admitted to an ICU during the study period. Roughly one-third underwent elective procedures and two-thirds urgent surgery. Patients submitted to an urgent procedure presented higher severity and in-hospital mortality (24.6% versus 8.2%, p<0.001), while among those discharged alive, scheduled surgery patients had higher long-term mortality (28.9% versus 25.0%, odds ratio (OR): 1.21, 95% confidence interval (CI): 1.11-1.32). This difference in the long-term risk was statistically significant in the younger population. All surgical critically ill patients had a markedly increased risk of one-year mortality, compared to the general population, even after hospital discharge (urgent surgery: OR: 10.8, 95% CI: 9.0-12.9; elective surgery: OR: 14.6, 95% CI: 11.3-18.8).

Elective and urgent surgical patients admitted to the ICU demonstrate distinct clinical trajectories and require tailored follow-up strategies. Urgent surgery patients have higher short-term mortality, while elective surgical patients showed higher long-term mortality risk, particularly noticeable in younger cohorts. All surgical patients admitted to the ICU had a very high first-year risk of mortality.