The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients

Anastasiya Shchatsko; Laura N. Purcell; Christopher J. Tignanelli; Anthony Charles

doi:10.1177/0003134820956353

The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients

Anastasiya Shchatsko, Laura N. Purcell, Christopher J. Tignanelli, Anthony Charles

Surgery

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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)
Pages (from-to)	1230-1237
Number of pages	8
Journal	American Surgeon
Volume	87
Issue number	8
DOIs	https://doi.org/10.1177/0003134820956353
State	Published - Aug 2021

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the department of surgery, the University of North Carolina at North Carolina. LNP is funded by a grant from the NIH Fogarty International Center #D43TW009340. AC: Research reported in this manuscript was supported by the National Institute of Health under award NIH grant #5T32GM008450-23.

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

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title = "The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients",

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.",

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",

author = "Anastasiya Shchatsko and Purcell, {Laura N.} and Tignanelli, {Christopher J.} and Anthony Charles",

note = "Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the department of surgery, the University of North Carolina at North Carolina. LNP is funded by a grant from the NIH Fogarty International Center #D43TW009340. AC: Research reported in this manuscript was supported by the National Institute of Health under award NIH grant #5T32GM008450-23. Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2021",

month = aug,

doi = "10.1177/0003134820956353",

language = "English (US)",

volume = "87",

pages = "1230--1237",

journal = "American Surgeon",

issn = "0003-1348",

publisher = "Southeastern Surgical Congress",

number = "8",

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TY - JOUR

T1 - The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients

AU - Shchatsko, Anastasiya

AU - Purcell, Laura N.

AU - Tignanelli, Christopher J.

AU - Charles, Anthony

N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the department of surgery, the University of North Carolina at North Carolina. LNP is funded by a grant from the NIH Fogarty International Center #D43TW009340. AC: Research reported in this manuscript was supported by the National Institute of Health under award NIH grant #5T32GM008450-23. Publisher Copyright: © The Author(s) 2020.

PY - 2021/8

Y1 - 2021/8

N2 - 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.

AB - 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.

KW - critical care severity and operative intervention

KW - intensive care units and organ system surgery

KW - intensive care units prognosis in surgical patients

KW - Intensive Care Units

KW - Orthopedic Procedures/mortality

KW - Age Factors

KW - Hospital Mortality

KW - Humans

KW - Middle Aged

KW - Urogenital Surgical Procedures/mortality

KW - Cost of Illness

KW - Critical Illness/mortality

KW - Male

KW - Cardiovascular Surgical Procedures/mortality

KW - Surgical Procedures, Operative/adverse effects

KW - United States/epidemiology

KW - Dermatologic Surgical Procedures/mortality

KW - Female

KW - Poisson Distribution

KW - Aged

KW - Digestive System Surgical Procedures/mortality

KW - Retrospective Studies

KW - APACHE

KW - Neurosurgical Procedures/mortality

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DO - 10.1177/0003134820956353

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ER -

The Effect of Organ System Surgery on Intensive Care Unit Mortality in a Cohort of Critically Ill Surgical Patients

Abstract

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