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

Victor A Vakayil; Nick E Ingraham; Alexandria J. Robbins; Rebecca Freese; Elise F. Northrop; Melissa E. Brunsvold; Kathryn M. Pendleton; Anthony Charles; Jeffrey G. Chipman; Christopher J. Tignanelli

doi:10.1097/TA.0000000000002768

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

Victor A Vakayil, Nick E Ingraham, Alexandria J. Robbins, Rebecca Freese, Elise F. Northrop, Melissa E. Brunsvold, Kathryn M. Pendleton, Anthony Charles, Jeffrey G. Chipman, Christopher J. Tignanelli

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

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 language	English (US)
Pages (from-to)	279-288
Number of pages	10
Journal	Journal of Trauma and Acute Care Surgery
Volume	89
Issue number	2
DOIs	https://doi.org/10.1097/TA.0000000000002768
State	Published - 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

Publisher link

10.1097/TA.0000000000002768

Find It

Find It at U of M Libraries

Cite this

@article{acdd05d648db43ccb7bad8ce892a1be3,

title = "Epidemiological trends of surgical admissions to the intensive care unit in the United States",

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.",

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",

author = "Vakayil, {Victor A} and Ingraham, {Nick E} and Robbins, {Alexandria J.} and Rebecca Freese and Northrop, {Elise F.} and Brunsvold, {Melissa E.} and Pendleton, {Kathryn M.} and Anthony Charles and Chipman, {Jeffrey G.} and Tignanelli, {Christopher J.}",

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: {\textcopyright} Wolters Kluwer Health, Inc. All rights reserved.",

year = "2020",

month = aug,

day = "1",

doi = "10.1097/TA.0000000000002768",

language = "English (US)",

volume = "89",

pages = "279--288",

journal = "Journal of Trauma and Acute Care Surgery",

issn = "2163-0755",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

TY - JOUR

T1 - Epidemiological trends of surgical admissions to the intensive care unit in the United States

AU - Vakayil, Victor A

AU - Ingraham, Nick E

AU - Robbins, Alexandria J.

AU - Freese, Rebecca

AU - Northrop, Elise F.

AU - Brunsvold, Melissa E.

AU - Pendleton, Kathryn M.

AU - Charles, Anthony

AU - Chipman, Jeffrey G.

AU - Tignanelli, Christopher J.

N1 - 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.

PY - 2020/8/1

Y1 - 2020/8/1

N2 - 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.

AB - 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.

KW - Surgical ICU

KW - functional status

KW - incidence

KW - length of stay

KW - mortality

KW - Facilities and Services Utilization

KW - Humans

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Hospital Mortality/trends

KW - United States/epidemiology

KW - Surgical Procedures, Operative/standards

KW - Time Factors

KW - Intensive Care Units/standards

KW - Adult

KW - Female

KW - Retrospective Studies

KW - Outcome Assessment, Health Care

KW - APACHE

UR - http://www.scopus.com/inward/record.url?scp=85089128613&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85089128613&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002768

DO - 10.1097/TA.0000000000002768

M3 - Article

C2 - 32384370

AN - SCOPUS:85089128613

SN - 2163-0755

VL - 89

SP - 279

EP - 288

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

IS - 2

ER -

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

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

Publisher link

Find It

Other files and links

Fingerprint

Cite this