• Jukka Takala, André Moser, Matti Reinikainen, Tero Varpula, Rahul Raj, and Stephan M Jakob.
• Department of Intensive Care Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: jukka.takala@med.unibe.ch.
• J Crit Care. 2022 Oct 1; 71: 154110.

PurposeThe resource use of cardiac surgery and neurosurgery patients likely differ from other ICU patients. We evaluated the relevance of these patient groups on overall ICU resource use.MethodsSecondary analysis of 69,862 patients in 17 ICUs in Finland, Estonia, and Switzerland in 2015-2017. Direct costs of care were allocated to patients using daily Therapeutic Intervention Scoring System (TISS) scores and ICU length of stay (LOS). The ratios of observed to severity-adjusted expected resource use (standardized resource use ratios; SRURs), direct costs and outcomes were assessed before and after excluding cardiac surgery or cardiac and neurosurgery.ResultsCardiac surgery and neurosurgery, performed only in university hospitals, represented 22% of all ICU admissions and 15-19% of direct costs. Cardiac surgery and neurosurgery were excluded with no consistent effect on SRURs in the whole cohort, regardless of cost separation method. Excluding cardiac surgery or cardiac surgery plus neurosurgery had highly variable effects on SRURs of individual university ICUs, whereas the non-university ICU SRURs decreased.ConclusionsCardiac and neurosurgery have major effects on the cost structure of multidisciplinary ICUs. Extending SRUR analysis to patient subpopulations facilitates comparison of resource use between ICUs and may help to optimize resource allocation.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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