Perioperative medicine & outcomes
Observational study for perioperative intensive care unit (OPICU): Planned and unplanned Intensive Care Unit (ICU) admissions, follow-up, discharge, and outcomes
Authors' conclusion
Integrating modified Wang criteria, POSSUM scores, intraoperative complications, emergency status, and ASA class >2 is effective in predicting the necessity of ICU admission.
Study context
- Population
- Adult inpatient surgery cases evaluated preoperatively across 75 ICUspreoperatively evaluated patients, 1980 patients admitted to the ICU
- Participants
- 55,963 cases
- Exposure
- Inter-group outcomes across planned, unplanned, planned but not admitted and emergent ICU admission groups
- PBNAGn = 411
- Outcome
- Planned ICU admission
Main finding
As reported in the abstract
Planned for ICU admission, of 55,963 preoperatively evaluated patients
2764
4.9%
Could not be admitted because of limited ICU beds, of the 2764 planned
804 of 2764
Did not require postoperative ICU care (PBNAG), of the 1960 with a planned ICU admission
411 of 1960
14.8% of 2764
Observational data: associations, not effects.
Further findings
Independent risk factors for UPAG
| Comparison | OR for UPAG |
|---|---|
| Emergency surgery | 12.4 |
| Intraoperative complications | 3.1 |
| ASA >2 | 2.7 |
| Outcome | PAG | UPAG | EAG | P value |
|---|---|---|---|---|
| ICU admissionShare of ICU admissions | 78.2% | 9.1% | 12.5% | |
| ICU benefit indicators (e.g., vasopressor need, prolonged ventilation >12 h, arrest events)UPAG and EAG vs PAG · significantly higher in UPAG and EAG | P < 0.001 | |||
| ICU and 90-day mortalityPeaking in the EAG group | — not stated in the abstract | — not stated in the abstract | ICU and 90-day mortality 18.1% and 18.9% |
— not stated in the abstract
- ICU admission — Patients admitted to the ICU
- 1980 patients (3.09% of all cases)
- ICU and 90-day mortality — Overall ICU and 90-day mortality rates
- 5.9% and 7.5%
POSSUM scores
- POSSUM scores effectively differentiated PBNAG (lower) and EAG (higher) from PAG
Independent risk factors for UPAG
- Minimally invasive surgery and regional anesthesia reduced ICU admissions
Original publication
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