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Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study
Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study
BackgroundPatient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.MethodsThis prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.ResultsOf 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.ConclusionsAfter risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
0007-0912
42-50
Bhome, Rahul
d7b1e0d3-5925-460a-871d-5f52f69c649b
STARSurg Collaborative
Bhome, Rahul
d7b1e0d3-5925-460a-871d-5f52f69c649b

Bhome, Rahul , STARSurg Collaborative (2019) Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study. British Journal of Anaesthesia, 122 (1), 42-50. (doi:10.1016/j.bja.2018.07.029).

Record type: Article

Abstract

BackgroundPatient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.MethodsThis prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.ResultsOf 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.ConclusionsAfter risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

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More information

Accepted/In Press date: 23 July 2018
e-pub ahead of print date: 20 September 2018
Published date: 1 January 2019

Identifiers

Local EPrints ID: 429969
URI: https://eprints.soton.ac.uk/id/eprint/429969
ISSN: 0007-0912
PURE UUID: 7ba8cfe6-9dca-45c9-949e-b8da00007dcc

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Date deposited: 09 Apr 2019 16:30
Last modified: 09 Apr 2019 16:30

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Author: Rahul Bhome

University divisions

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