Short‐ and long‐term mortality in major non‐cardiac surgical patients admitted to the intensive care unit

Abstract

Worldwide, more than 310 million surgical procedures are undertaken each year with an in-hospital mortality rate between 1.5% and 1.9% in developed countries. 1-3 High-risk patients represent a smaller proportion of the surgical population but accounts for more than 80% of the post-operative deaths. 2 A large database study reported a post-operative mortality of 0.42% in the standard surgical population and 12.3% in the high-risk population. 2 Post-operative complications seems to be the most important cause for poor surgical outcomes, admission to the intensive care unit (ICU) and shortand long-term post-operative mortality. 4-6 Patients undergoing major non-cardiac surgery make out a considerable proportion of the admissions to the ICU and utilise large amounts of resources. 7 While large population-based studies have characterised the high-risk surgical population in general, 2,3 few studies have specifically identified and characterised the high-risk surgical population admitted to the ICU following surgery. By exploring factors associated with morbidity and mortality on the short and long term for this patient group, it might be possible to identify clinically modifiable factors leading to better outcomes. The aim of this study was to characterize patients admitted to the ICU following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. Background: The aim of this register-based cohort study was to characterize patients admitted to the intensive care unit (ICU) following non-cardiac surgery and identify risk factors associated with 30-days, 90-days and 1-year mortality after ICU admission. Methods: Patients aged 18+ years admitted to the intensive care unit within 30-days of non-cardiac surgery at four Capital Region hospitals in Denmark between January 2005 and December 2014 were included. Patients were identified through the Danish National Patient Register. The outcomes were 30-days, 90-days and 1-year mortality after ICU admission. Unadjusted and multivariate logistic regression analyses were performed to identify independent risk factors of mortality. Results:The study included 3311 ICU patients. Gastrointestinal surgery accounted for 71.3%, orthopaedic surgery for 18.4% and urologic surgery for 10.2% of the population. For the total population, the median length of stay in hospital was 18 days (9-36, 25th-75th percentile) and 2 days (1-4, 25th-75th percentile) in the ICU. Thirtydays, 90-days and 1-year mortality were 37.8%, 44.5% and 51.2% respectively.Mortality within the ICU was 22.3% while the post-ICU in-hospital mortality was 19.4%. Higher age, comorbidity, delayed ICU admission, acute surgery, and gastrointestinal and orthopaedic surgery increased 30-days, 90-days and 1-year mortality.Conclusions: Short-and long-term mortality in non-cardiac surgical patients admitted to the ICU is very high, especially among the elderly comorbid patients undergoing acute surgery. Future research should focus on targeting clinically modifiable r...

The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis

“…Our study result was comparable with study findings of Tanzania [ 7 ], Uganda [ 30 ], Nigeria [ 32 ], and Pakistan [ 55 ]. However, our findings were higher than reports from the United States of America, Ireland, Denmark, Scotland, China, and Thailand [ 9 , 29 , [56] , [57] , [58] , [59] , [60] ]. This notable disparity could be attributable to differences in the availability of resources in the ICU, including medications and medical equipment [ 61 ].…”

Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study

“…Our result is also higher than studies conducted in most high and middle-income countries, including Ireland, China, Brazil, Thailand, and South Africa ( 4 , 8 , 9 , 22 , 23 ). This discrepancy might have resulted from the shortage of essential medications and equipment, which could significantly affect survival from the SICU ( 24 , 25 ).…”

“…Our result is also higher than studies conducted in most high and middle-income countries, including Ireland, China, Brazil, Thailand, Creatinine (mg/dl), Median (IQR) 1.5 (1.0, 1.9) 0.6 (0.5, 0.9) 0.8 (0.6, 1.5) p, frequency; %, percentage; SpO2, peripheral oxygen saturation; mmHg, millimetre of mercury; WBC, white blood cell; SGOT, serum glutamic-oxaloacetic transaminase; SGT, serum glutamic pyruvic transaminase. and South Africa (4,8,9,22,23). This discrepancy might have resulted from the shortage of essential medications and equipment, which could significantly affect survival from the SICU (24, 25).…”

“…Patients who had had general surgery, neurosurgery, orthopedic, and traumatology operations were the most common types of surgical patients admitted to the intensive care unit (3). Although a colossal groups of surgical patients are being admitted to the ICU in high-income nations, the mortality rate is meager, which has remained consistent and lower than 25% (2,(4)(5)(6). In contrast, up to 50% of surgical patients die in the ICUs in low-income countries (7,8).…”

Intensive care patient survival after limiting life‐sustaining treatment—The FINNEOL* national cohort study

“…Some other studies also reported rather high survival among older patients after treatment limitation 28 . This appears to contradict many other reports on the general and surgical ICU population that indicated advancing age as a factor increasing mortality even after the control of pre‐existing morbidities 29‐33 12,21 .…”