Determinants of Outcome in Patients Admitted to a Surgical Intensive Care Unit
Introduction: Outcome in intensive care may be categorized as mortality or morbidity related. Mortality is an insufficient measure of Intensive Care Unit (ICU) outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. Length of stay may be seen as a surrogate marker for adverse outcome and increased resource use following surgery. The aim of the present study was to evaluate case fatality rates and the determinants of death and length of stay in patients admitted to a surgical ICU. Methods: The study was observational and prospective in a surgical ICU and all consecutive adult patients admitted between October 2004 and April 2005, who underwent noncardiac surgery, were enrolled. Patients were categorized according age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, type and duration of anesthesia, core temperature at admission, Length of stay (LOS) in the ICU and in the hospital, and mortality in the ICU and in the hospital. The Simplified Acute Physiology Score II (SAPS II) was calculated. Postoperative prolonged ICU stay was defined as intensive care lasting for seven days and longer. Results: The mean ICU LOS was 4.22 ± 8.76 days. Significant risk factors for staying longer in ICU were SAPS II (OR 1.08; 95% CI: 1.06-1.11, p < 0.001), ASA physical status (OR 3.00; 95% CI: 1.49-6.07, p = 0.002 for ASA III/IV patients) and emergency surgery (OR 6.56; 95% CI: 1.89-12.44, p < 0.001 for emergency surgery). Forty two (11.2%) patients died during hospitalization. Mortality was significantly associated with ASA physical status (OR 3.04; 95% CI: 1.41-6.56, p = 0.005 for ASA III/IV patients), emergency surgery (OR 5.40; 95% CI: 2.74-10.64, p < 0.001), SAPS II scores (OR 1.09; 95% CI: 1.07-1.20, p < 0.001) and longer stay in ICU (OR 8.05; 95% CI: 3.95-37.18, p < 0.001). Conclusions: Severity of disease and emergency surgery resulted in prolonged ICU stay and higher mortality. Staying longer in ICU is also a determinant of hospital mortality.
| Main Authors: | , , , , |
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| Format: | Digital revista |
| Language: | English |
| Published: |
ArquiMed - Edições Científicas AEFMUP
2007
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| Online Access: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0871-34132007000400002 |
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| Summary: | Introduction: Outcome in intensive care may be categorized as mortality or morbidity related. Mortality is an insufficient measure of Intensive Care Unit (ICU) outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. Length of stay may be seen as a surrogate marker for adverse outcome and increased resource use following surgery. The aim of the present study was to evaluate case fatality rates and the determinants of death and length of stay in patients admitted to a surgical ICU. Methods: The study was observational and prospective in a surgical ICU and all consecutive adult patients admitted between October 2004 and April 2005, who underwent noncardiac surgery, were enrolled. Patients were categorized according age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, type and duration of anesthesia, core temperature at admission, Length of stay (LOS) in the ICU and in the hospital, and mortality in the ICU and in the hospital. The Simplified Acute Physiology Score II (SAPS II) was calculated. Postoperative prolonged ICU stay was defined as intensive care lasting for seven days and longer. Results: The mean ICU LOS was 4.22 ± 8.76 days. Significant risk factors for staying longer in ICU were SAPS II (OR 1.08; 95% CI: 1.06-1.11, p < 0.001), ASA physical status (OR 3.00; 95% CI: 1.49-6.07, p = 0.002 for ASA III/IV patients) and emergency surgery (OR 6.56; 95% CI: 1.89-12.44, p < 0.001 for emergency surgery). Forty two (11.2%) patients died during hospitalization. Mortality was significantly associated with ASA physical status (OR 3.04; 95% CI: 1.41-6.56, p = 0.005 for ASA III/IV patients), emergency surgery (OR 5.40; 95% CI: 2.74-10.64, p < 0.001), SAPS II scores (OR 1.09; 95% CI: 1.07-1.20, p < 0.001) and longer stay in ICU (OR 8.05; 95% CI: 3.95-37.18, p < 0.001). Conclusions: Severity of disease and emergency surgery resulted in prolonged ICU stay and higher mortality. Staying longer in ICU is also a determinant of hospital mortality. |
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