Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries
Articolo
Data di Pubblicazione:
2017
Abstract:
Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10–5.21]; p < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.
Tipologia CRIS:
Articolo su Rivista
Keywords:
Critical care/utilisation; Postoperative care/methods; Postoperative care/statistics and numerical data; Surgical procedures, operative/mortality; Critical Care and Intensive Care Medicine
Elenco autori:
Kahan, Brennan C.; Koulenti, Desponia; Arvaniti, Kostoula; Beavis, Vanessa; Campbell, Douglas; Chan, Matthew; Moreno, Rui; Pearse, Rupert M.; Beattie, S.; Clavien, Pa.; Demartines, N.; Fleisher, La.; Grocott, M.; Haddow, J.; Hoeft, A.; Holt, P.; Pritchard, N.; Rhodes, A.; Wijeysundera, D.; Wilson, M.; Ahmed, T.; Everingham, K.; Hewson, R.; Januszewska, M.; Phull, Mk.; Halliwell, R.; Shulman, M.; Myles, P.; Schmid, W.; Hiesmayr, M.; Wouters, P.; de Hert, S.; Lobo, S.; Fang, X.; Rasmussen, L.; Futier, E.; Biais, M.; Venara, A.; Slim, K.; Sander, M.; Kulkarni, A.; Chandra, S.; Tantri, A.; Geddoa, E.; Abbas, M.; Della Rocca, G.; Sivasakthi, D.; Mansor, M.; Luna, P.; Bouwman, A.; Buhre, W.; Short, T.; Osinaike, T.; Matos, R.; Grigoras, I.; Kirov, M.; Protsenko, D.; Biccard, B.; Aldecoa, C.; Chew, M.; Hofer, C.; Hubner, M.; Ditai, J.; Szakmany, T.; Ferguson, M.; Macmahon, M.; Cherian, R.; Currow, H.; Kanathiban, K.; Gillespie, D.; Pathmanathan, E.; Phillips, K.; Reynolds, J.; Rowley, J.; Douglas, J.; Kerridge, R.; Garg, S.; Bennett, M.; Jain, M.; Alcock, D.; Terblanche, N.; Cotter, R.; Leslie, K.; Stewart, M.; Zingerle, N.; Clyde, A.; Hambidge, O.; Rehak, A.; Cotterell, S.; Binh Quan Huynh, W.; Mcculloch, T.; Ben-Menachem, E.; Egan, T.; Cope, J.; Fellinger, P.; Haselberger, S.; Holaubek, C.; Lichtenegger, P.; Scherz, F.; Hoffer, F.; Cakova, V.; Eichwalder, A.; Fischbach, N.; Klug, R.; Schneider, E.; Vesely, M.; Wickenhauser, R.; Grubmueller, Kg.; Leitgeb, M.; Lang, F.; Toro, N.; Bauer, M.; Laengle, F.; Mayrhofer, T.; Buerkle, C.; Forstner, K.; Germann, R.; Rinoesl, H.; Schindler, E.; Trampitsch, E.; Fritsch, G.; Szabo, C.; Bidgoli, J.; Verdoodt, H.; Forget, P.; Kahn, D.; Lois, F.; Momeni, M.; Prégardien, C.; Pospiech, A.; Steyaert, A.; Veevaete, L.; De Kegel, D.; De Jongh, K.; Foubert, L.; Smitz, C.; Vercauteren, M.; Poelaert, J.; Van Mossevelde, V.; Abeloos, J.; Bouchez, S.; Coppens, M.; De Baerdemaeker, L.; Deblaere, I.; De Bruyne, A.; Fonck, K.; Heyse, B.; Jacobs, T.; Lapage, K.; Moerman, A.; Neckebroek, M.; Parashchanka, A.; Roels, N.; Van Den Eynde, N.; Vandenheuvel, M.; Van Limmen, J.; Vanluchene, A.; Vanpeteghem, C.; Wyffels, P.; Huygens, C.; Vandenbempt, P.; Van de Velde, M.; Dylst, D.; Janssen, B.; Schreurs, E.; Aleixo, Fb.; Candido, K.; Dias Batista, H.; Guimarães, M.; Guizeline, J.; Hoffmann, J.; Lobo, Sm.; Lobo, Fr.; Nascimento, V.; Nishiyama, K.; Pazetto, L.; Souza, D.; Souza Rodrigues, R.; Vilela Dos Santos, A. M.; Jardim, J.; Silva, J.; do Nascimento Junior, P.; Baio, Th.; Pereira de Castro, Gi.; Watanabe Oliveira, Hr.; Amendola, Cp.; Cardoso, G.; Ortega, D.; Brotto, Af.; De Oliveira, Mc.; Réa-Neto, A.; Dias, F.; Azambuja, P.; Knibel, Mf.; Martins, A.; Almeida, W.; Neto, Cn.; Tardelli, Ma.; Caser, E.; Machado, M.; Aguzzoli, C.; Baldisserotto, S.; Beck Tabajara, F.; Bettega, F.; Rodrigues Júnior, Hc.; de Gasperi, J.; Faina, L.; Nolasco, Mf.; da Costa Fischer, Bf.; de Campos Ferreira, Mf.; Hartmann, C.; Kliemann, M.; Ribeiro, Glh.; Fraga, Jm.; Netto, Tm.; Pozza, Lv.; Wendling, Pr.; Azevedo, C.; Garcia, J.; Lopes, M.; Maia, B.; Maselli, P.; Melo, R.; Mendes, W.; Neves, M.; Ney, J.; Piras, C.; Applewhaite, C.; Carr, A.; Chow, L.; Duttchen, K.; Foglia, J.; Greene, M.; Hinther, A.; Houston, K.; Mccormick, Tj.; Mikhayel, J.; Montasser, S.; Ragan, A.; Suen, A.; Woolsey, A.; Yu, Hc.; Funk, D.; Kowalski, S.; Legaspi, R.; Mcdonald, H.; Siddiqui, F.; Pridham, J.; Rowe, B.; Sampson, S.; Thiessen, B.; Zbitnew, G.; Bernard, A.; George, R.; Jones, P.; Moor, R.; Siddiqui, N.; Wolfer, A.; Tran, D.; Winch, D.; Dobson, G.; Mccormick, T.; Montasser, O.; Hall, R.; Baghirzada, L.; Dai, Sy.; Hare, G.; Lee, E.; Shastri, U.; Tsui, A.; Yagnik, A.; Alvares, D.; Choi, S.; Dwyer, H.; Flores, K.; Mccartney, C.; Somascanthan, P.; Carroll, J.; Pazmino-Canizares, J.; Ami, N.; Chan, V.; Perlas, A.; Argue, R.; Lavis, K.; Mayson, K.; Cao, Y.; Gao, H.; Hu, T.; Lv, J.; Yang, J.; Yang, Y.; Zhong, Y.; Zhou, J
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