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Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study - 17/1/2019


Br J Anaesth 2019; 122: 42-50

Introduction


The aim of this study was to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

 

Methods


This 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.

 

Results


Of 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 to 19.97) than planned admissions (OR 2.32, 95% CI 1.43 to 3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI 46.8 to 51.9%; p<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

 

Conclusions

The authors conclude that, after risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. They state that this is likely to represent appropriate admission of the highest-risk patients, and suggest that planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. They point out that substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.


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ArticleDate:20190117
SiteSection: Abstracts



 
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