Increased ICU Resource Needs for an Academic Emergency General Surgery Service*

Lissauer, Matthew; Galvagno, Samuel M.; Rock, Peter; Narayan, Mayur; Shah, Paulesh K.; Hong, Caron M.; Diaz, José J.

doi:10.1097/ccm.0000000000000099

Cited by 35 publications

(21 citation statements)

References 26 publications

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“…As previously described, it is the primary ICU for acute care, general, vascular, transplant, thoracic, orthopedic, otolaryngology, and oralmaxillofacial surgery patients requiring critical care [30]. It also serves as an ancillary ICU for neurosurgical patients and admits medical patients on an emergency basis when nonsurgical ICUs have reached maximum capacity.…”

Section: Methodsmentioning

confidence: 96%

Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

Harris

McCrone

Koo

et al. 2015

Journal of Critical Care

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Section: Methodsmentioning

confidence: 96%

Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

Harris

McCrone

Koo

et al. 2015

Journal of Critical Care

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“…As a subgroup analysis of a previously described SICU cohort ( 1 ), the purpose of this report was to serve as a distinctly separate focus on AKI among critically ill vascular surgery patients. Briefly, the original cohort of SICU admissions during January–December 2012 was identified from a prospectively maintained Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner, Kansas City) ( 24 , 25 ). Clinical data was retrospectively obtained from the database and by chart review, and 1-year post-discharge vital status was determined from the Social Security Death Index ( 1 ).…”

Section: Methodsmentioning

confidence: 99%

Acute Kidney Injury in Critically Ill Vascular Surgery Patients is Common and Associated with Increased Mortality

et al. 2015

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Introduction: Vascular surgery patients have multiple risk factors for renal dysfunction, but acute kidney injury (AKI) is poorly studied in this group. The purpose of this study was to define the incidence, risk factors, and outcomes of AKI in high-risk vascular patients.Methods: Critically ill vascular surgery patients admitted during January–December 2012 were retrospectively analyzed with 1-year follow-up. The endpoint was AKI by established RIFLE creatinine criteria. The primary analysis was between patients with or without AKI, with secondary analysis of post-operative AKI. Outcomes were inpatient and 1-year mortality, inpatient lengths of stay, and discharge renal function.Results: One-hundred and thirty six vascular surgery patients were included, representing 27% of all vascular surgery admissions during the study period. Sixty-five (48%) developed AKI. Independent global risk factors for AKI were diabetes, increasing critical illness severity, and sepsis. While intraoperative blood loss and hypotension were associated with subsequent renal dysfunction, post-operative AKI rates were similar for patients undergoing aortic, carotid, endovascular, or peripheral vascular procedures. All RIFLE grades of AKI were associated with worse outcomes. Overall, patients with AKI had significantly increased short- and long-term mortality, longer inpatient lengths of stay, and worse discharge renal function.Conclusion: AKI is common among critically ill vascular surgery patients. Importantly, the type of surgical procedure appears to be less important than intra- and perioperative management in determining renal dysfunction. Regardless of its severity, AKI is a clinically significant complication that is associated with substantially worse patient outcomes.

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“…In this setting, the shortage of available ICU beds is impacted by a lack of high dependency facilities and difficulty with transfer of patients to tertiary centres. Critical care beds are utilised for a wide case-mix of general surgical cases including trauma, emergency general surgery and postoperatively for major elective surgery [6].…”

Section: Introductionmentioning

confidence: 99%

Utilisation of critical care services for surgical patients in a model three hospital

et al. 2019

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Background The demand for intensive care unit (ICU) beds in the surgical population has increased in recent years. This is due to increased complexity of operative interventions, development of critical care services and improved availability of technologies. The number of beds in ICUs nationwide remains limited. In model three hospitals, this is further impacted by a lack of high dependency unit (HDU) facilities and difficulty with transfer of patients to tertiary centres. Aim To assess utilisation of ICU resources amongst general surgical patients admitted for elective and emergency procedures to Mayo University Hospital. Methods A prospective study was conducted between 31/10/2016 and 01/11/2017 on general surgical patients admitted to the intensive care unit. The ICU register and ICU database were used to collect data regarding patient demographics, admission by specialty, ICU length of stay, interventions performed, level of care, infection status and antimicrobial usage. Results Eight hundred seventy-three patients were admitted to the ICU. One hundred thirty-four (15.35%) were surgical admissions, of which 55 were elective and 79 were emergency. The most common cause for emergency admission to ICU was emergency laparotomy. Mean ICU length of stay (LOS) for surgical patients was 3.6 days. Three (2.2%) surgical patients were transferred to model four hospitals. Conclusions This study demonstrates the need to protect sufficient numbers of ICU beds for delivery of emergency surgical care. It highlights the potential utility of an HDU in this setting. The introduction of such a facility would impact cost savings and increase access for those requiring definitive ICU level care.

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Increased ICU Resource Needs for an Academic Emergency General Surgery Service*

Cited by 35 publications

References 26 publications

Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

Epidemiology and outcomes of acute kidney injury in critically ill surgical patients

Acute Kidney Injury in Critically Ill Vascular Surgery Patients is Common and Associated with Increased Mortality

Utilisation of critical care services for surgical patients in a model three hospital

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