Abstract
BACKGROUND: The critical illness burden in the United States is growing with an aging population obtaining surgical intervention despite age-related comorbidities. The effect of organ system surgical intervention on intensive care units (ICUs) mortality is unknown.
METHODS: We performed an 8-year retrospective analysis of surgical ICU patients. Poisson regression analysis was performed assessing the relative risk of in-hospital mortality based on surgical intervention.
RESULTS: Of 468 000 ICU patients included, 97 968 (20.9%) were surgical admissions and 97 859 (99.9%) had complete outcomes data. Nonsurvivors were older (68.8 ± 15.4 vs. 62.7 ± 15.8 years, P < .001) with higher Acute Physiology, Age, Chronic Health Evaluation (APACHE) III Scores (81.4 ± 33.6 vs. 46.7 ± 20.1, P < .001. Patients with gastrointestinal (GI) (n = 1,558, 7.8%), musculoskeletal (n = 277, 5.5%), and neurological (n = 884, 4.6%) system operations had the highest mortality. Upon Poisson regression model, patients undergoing emergent operative interventions on the neurologic system (RR 1.86, 95% CI 1.67-2.07, P < .001) had increased relative risk of mortality when compared to emergent operative interventions on the cardiovascular system after controlling for pertinent covariates. Elective operative interventions on the respiratory (RR 2.39, 95% CI 2.03-2.80, P < .001), GI (RR 2.34, 95% CI 2.10-2.61, P < .001), and skin and soft tissue (RR 2.26, 95% CI 1.77-2.89, P < .001) systems had increased risk of mortality when compared to elective cardiovascular system surgery after controlling for pertinent covariates.
CONCLUSION: We found significant differences in the risk of mortality based on organ system of operative intervention. The prognostication of critically ill patients undergoing surgical intervention is currently not accounted for in prognostic scoring systems.
Original language | English (US) |
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Pages (from-to) | 1230-1237 |
Number of pages | 8 |
Journal | American Surgeon |
Volume | 87 |
Issue number | 8 |
DOIs | |
State | Published - Aug 2021 |
Bibliographical note
Publisher Copyright:© The Author(s) 2020.
Keywords
- critical care severity and operative intervention
- intensive care units and organ system surgery
- intensive care units prognosis in surgical patients
- Intensive Care Units
- Orthopedic Procedures/mortality
- Age Factors
- Hospital Mortality
- Humans
- Middle Aged
- Urogenital Surgical Procedures/mortality
- Cost of Illness
- Critical Illness/mortality
- Male
- Cardiovascular Surgical Procedures/mortality
- Surgical Procedures, Operative/adverse effects
- United States/epidemiology
- Dermatologic Surgical Procedures/mortality
- Female
- Poisson Distribution
- Aged
- Digestive System Surgical Procedures/mortality
- Retrospective Studies
- APACHE
- Neurosurgical Procedures/mortality
PubMed: MeSH publication types
- Journal Article