Epidemiological trends of surgical admissions to the intensive care unit in the United States

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Abstract

BACKGROUND: Epidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs.

METHODS: We performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes.

RESULTS: We evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period.

CONCLUSION: Temporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training.

LEVEL OF EVIDENCE: Economic/decision, level IV.Epidemiologic, level IV.

Original languageEnglish (US)
Pages (from-to)279-288
Number of pages10
JournalJournal of Trauma and Acute Care Surgery
Volume89
Issue number2
DOIs
StatePublished - Aug 1 2020

Bibliographical note

Funding Information:
For all authors, no conflicts are declared. This research was supported by the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health's National Center for Advancing Translational Sciences.

Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Surgical ICU
  • functional status
  • incidence
  • length of stay
  • mortality
  • Facilities and Services Utilization
  • Humans
  • Length of Stay/statistics & numerical data
  • Male
  • Hospital Mortality/trends
  • United States/epidemiology
  • Surgical Procedures, Operative/standards
  • Time Factors
  • Intensive Care Units/standards
  • Adult
  • Female
  • Retrospective Studies
  • Outcome Assessment, Health Care
  • APACHE

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural

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