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

Research output: Contribution to journalArticlepeer-review

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 languageEnglish (US)
Pages (from-to)1230-1237
Number of pages8
JournalAmerican Surgeon
Volume87
Issue number8
DOIs
StatePublished - 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

PubMed: MeSH publication types

  • Journal Article

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