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Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

Prospective analysis of data from 27 countries

descriptionPublicationkeyboard_double_arrow_right Article 25 Apr 2017 United Kingdom, Italy, Italy, United Kingdom, Netherlands, Netherlands, Germany, Italy, United Kingdom, Italy, Australia, Italy, Belgium, Portugal, United Kingdom, Italy, Italy, China (People's Republic of) Publisher:Springer Science and Business Media LLCJournal:Intensive Care Medicine, volume 43, pages 971-979 (issn: 0342-4642, eissn: 1432-1238,

Authors: Brennan C. Kahan; Desponia Koulenti; Kostoula Arvaniti; Vanessa Beavis; Douglas Campbell; Matthew Chan; Rui Moreno; +193 Authors

Brennan C. Kahan; Desponia Koulenti; Kostoula Arvaniti; Vanessa Beavis; Douglas Campbell; Matthew Chan; Rui Moreno; Rupert M. Pearse; Scott Beattie; Pierre-Alain Clavien; Nicolas Demartines; Lee A Fleisher; Mike Grocott; James Haddow; Andreas Hoeft; Peter Holt; Rui Moreno; Naomi Pritchard; Andrew Rhodes; Duminda Wijeysundera; Matt Wilson; Tahania Ahmed; Kirsty Everingham; Russell Hewson; Marta Januszewska; Rupert M Pearse; Mandeep-Kaur Phull; Richard Halliwell; Mark Shulman; Paul Myles; Werner Schmid; Michael Hiesmayr; Patrick Wouters; Stefan de Hert; Suzana Lobo; Scott Beattie; Duminda Wijeysundera; Xiangming Fang; Lars Rasmussen; Emmanuel Futier; Matthieu Biais; Aurélien Venara; Karem Slim; Michael Sander; Despoina Koulenti; Kostoula Arvaniti; Mathew Chan; Atul Kulkarni; Susilo Chandra; Aida Tantri; Emad Geddoa; Muntadhar Abbas; Giorgio Della Rocca; Datin Sivasakthi; Marzida Mansor; Pastor Luna; Arthur Bouwman; Wolfgang Buhre; Vanessa Beavis; Douglas Campbell; Tim Short; Tunde Osinaike; Ricardo Matos; Ioana Grigoras; Mikhail Kirov; Denis Protsenko; Bruce Biccard; Cesar Aldecoa; Michelle Chew; Christoph Hofer; Martin Hubner; James Ditai; Tamas Szakmany; Lee Fleisher; Marissa Ferguson; Michael MacMahon; Mark Shulman; Ritchie Cherian; Helen Currow; Kathirgamanathan Kanathiban; David Gillespie; Edward Pathmanathan; Katherine Phillips; Jenifer Reynolds; Joanne Rowley; Jeanene Douglas; Ross Kerridge; Helen Currow; Sameer Garg; Michael Bennett; Megha Jain; David Alcock; Nico Terblanche; Rochelle Cotter; Kate Leslie; Marcelle Stewart; Nicolette Zingerle; Antony Clyde; Oliver Hambidge; Adam Rehak; Sharon Cotterell; Wilson Binh Quan Huynh; Timothy McCulloch; Erez Ben-Menachem; Thomas Egan; Jennifer Cope; Richard Halliwell; Paul Fellinger; Simone Haselberger; Caroline Holaubek; Paul Lichtenegger; Florian Scherz; Werner Schmid; Franz Hoffer; Veronika Cakova; Andreas Eichwalder; Norbert Fischbach; Reinhold Klug; Elisabeth Schneider; Martin Vesely; Reinhart Wickenhauser; Karl Gernot Grubmueller; Marion Leitgeb; Friedrich Lang; Nancy Toro; Marlene Bauer; Friedrich Laengle; Thomas Mayrhofer; Christian Buerkle; Karin Forstner; Reinhard Germann; Harald Rinoesl; Elke Schindler; Ernst Trampitsch; Gerhard Fritsch; Christian Szabo; Jawad Bidgoli; Hans Verdoodt; Patrice Forget; David Kahn; Fernande Lois; Mona Momeni; Caroline Prégardien; Audrey Pospiech; Arnaud Steyaert; Laurent Veevaete; Dirk De Kegel; Karen De Jongh; Luc Foubert; Carine Smitz; Marcel Vercauteren; Jan Poelaert; Veerle Van Mossevelde; Jacques Abeloos; Stefaan Bouchez; Marc Coppens; Luc De Baerdemaeker; Isabel Deblaere; Ann De Bruyne; Stefan De Hert; Kristine Fonck; Bjorn Heyse; Tom Jacobs; Koen Lapage; Anneliese Moerman; Martine Neckebroek; Aliaksandra Parashchanka; Nathalie Roels; Nancy Van Den Eynde; Michael Vandenheuvel; Jurgen Van Limmen; Ann Vanluchene; Caroline Vanpeteghem; Patrick Wouters; Piet Wyffels; Christel Huygens; Punitha Vandenbempt; Marc Van de Velde; Dimitri Dylst; Bruno Janssen; Evelien Schreurs; Fábia Berganton Aleixo; Keulle Candido; Hugo Dias Batista; Mario Guimarães; Jaqueline Guizeline; João Hoffmann; Suzana M Lobo; Francisco Ricardo Lobo; Vinícius Nascimento; Katia Nishiyama; Lucas Pazetto; Daniela Souza; Rodrigo Souza Rodrigues; Ana Maria Vilela Dos Santos; Jaquelline Jardim; Joao Silva; Paulo do Nascimento Junior; Thalissa Hermínia Baio; Gabriel Isaac Pereira de Castro;

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

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Abstract

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.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.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.We did not identify any survival benefit from critical care admission following surgery.

Countries

United Kingdom, Italy, Italy, United Kingdom, Netherlands, Netherlands, Germany, Italy, United Kingdom, Italy, Australia, Italy, Belgium, Portugal, United Kingdom, Italy, Italy, China (People's Republic of)

Related Organizations

University of Salford
United Kingdom
Amsterdam UMC, location VUmc
Netherlands
Sapienza University of Rome
Italy
Alma Mater Studiorum University of Bologna
Italy
Vrije Universiteit Brussel
Belgium

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Keywords

Male, surgical mortality, HSJ UCI, high risk patient, Critical Care and Intensive Care Medicine, postoperative period, intensive care unit, surgery, Perioperative Care/methods, Surgical procedures, middle aged, statistics and numerical data, Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, middle income country, Postoperative Period, Prospective Studies, Postoperative care/methods, Critical care/utilisation; Postoperative care/methods; Postoperative care/statistics and numerical data; Surgical procedures, operative/mortality; Adult; Elective Surgical Procedures; Female; Hospitalization; Humans; Intensive Care Units; Length of Stay; Logistic Models; Male; Middle Aged; Perioperative Care; Postoperative Period; Prospective Studies; Critical Care and Intensive Care Medicine, intensive care, Postoperative care/method, Elective Surgical Procedures/mortality, adult, fluid output, clinical trial, Middle Aged, cohort analysis, fluid administration, Hospitalization, hospital patient, Intensive Care Units, female, operative/mortality, Length of Stay/statistics & numerical data, statistics, Elective Surgical Procedures, Intensive Care Units/statistics & numerical data, outcome, Female, 2706 Critical Care and Intensive Care Medicine, hospitalization, prospective study, Adult, Postoperative care/statistics and numerical data, Critical care/utilisation, perioperative period, 610, Postoperative care; methods; Postoperative care; statistics and numerical data; Surgical procedures; operative/mortality; Critical care/utilisation, Perioperative Care, 618, evaluation study, length of stay, male, death, 617, Humans, controlled study, human, procedures, Elective Surgical Procedures/statistics & numerical data, Hospitalization/statistics & numerical data, hospital mortality, controlled clinical trial, high income country, statistical model, Length of Stay, logistic regression analysis, major clinical study, mortality, postoperative care, Surgical procedures, operative/mortality, elective surgery, multicenter study, Logistic Models, septic shock, Critical care/utilisation; Postoperative care/methods; Postoperative care/statistics and numerical data; Surgical procedures, operative/mortality; Critical Care and Intensive Care Medicine

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