Unplanned Intensive Care Unit Admission following Elective Surgical Adverse Events: Incidence, Patient Characteristics, Preventability, and Outcome

Abstract

Context:Adverse events (AEs) are a persistent and an important reason for Intensive Care Unit (ICU) admission. They lead to death, disability at the time of discharge, unplanned ICU admission (UIA), and prolonged hospital stay. They impose large financial costs on health-care systems.Aims:This study aimed to determine the incidence, patient characteristics, type, preventability, and outcome of UIA following elective surgical AE.Settings and Design:This is a single-center prospective study.Methods:Analysis of 15,372 elective surgical procedures was performed. We defined UIA as an ICU admission that was not anticipated preoperatively but was due to an AE occurring within 5 days after elective surgery.Statistical Analysis:Descriptive analysis using SPSS software version 18 was used for statistical analysis.Results:There were 75 UIA (0.48%) recorded during the 2-year study period. The average age of patients was 54.64 ± 18.02 years. There was no sex predominance, and the majority of our patients had an American Society of Anesthesiologist classes 1 and 2. Nearly 29% of the UIA occurred after abdominal surgery and 22% after a trauma surgery. Regarding the causes of UIA, we observed that 44 UIA (58.7%) were related to surgical AE, 24 (32%) to anesthetic AE, and 7 (9.3%) to postoperative AE caused by care defects. Twenty-three UIA were judged as potentially preventable (30.7%). UIA was associated with negative outcomes, including increased use of ICU-specific interventions and high mortality rate (20%).Conclusions:Our analysis of UIA is a quality control exercise that helps identify high-risk patient groups and patterns of anesthesia or surgical care requiring improvement.

Unplanned ICU transfer from post-anesthesia care unit following cerebral surgery: A retrospective study

“…Overall, the incidence of unplanned ICU transfer in PACU patients ranged from 0.4 to 1.01%. This is similar to the previously reported incidence of unplanned postoperative ICU transfer in adults (0.1–0.9%) [26-29] .…”

Unplanned hospital admission after ambulatory surgery: a retrospective, single cohort study

“…Unplanned hospital admissions may be associated with medical (patient, anesthesia, surgery) and social factors. 22 Another limitation is that we could not account for unplanned admission to hospitals outside of the MEDNAX system. Finally, CPT codes had the highest rate of missing data (27%) among variables with missing data.…”

“…Moreover, there are no studies that detail the incidence and risk factors for unplanned intensive care unit (ICU) admissions. [20][21][22] Unplanned ICU admissions is a validated measure of patient safety in surgical patients, 20 and may help identify at-risk outpatient surgery groups, procedures, and practices. [21][22][23] The objective of this study was to assess the incidence of unplanned hospital and ICU admissions/readmissions following ambulatory surgery centre (ASC) procedures in a large, regional community-based anesthesia practice and to identify factors associated with increased risk of their occurrence.…”

Effect of Rapid Response System on Unplanned Intensive Care Unit Admission after Elective Surgery

“…The incidence of UIA has been reported to vary from 0.12% to 0.79% [6][7][8]. These varying incidences of UIA among the literature were considered to be a result of differences in methods of data collection; prospective or retrospective design of the study; inclusion criteria; sample size; and definition of UIA as described by Meziane et al [6].…”