• Medicina intensiva · May 2020

    Postoperative intensive care unit admission does not affect outcomes in elective surgical patients with severe comorbidity.

    • T Ogawa, S Inoue, M Inada, and M Kawaguchi.
    • Division of Intensive Care, Nara Medical University, 840 Shijo-cho Kashihara, Nara 634-8521, Japan.
    • Med Intensiva. 2020 May 1; 44 (4): 216-225.

    ObjectiveThe impact of postoperative intensive care upon patient outcomes was evaluated by retrospectively investigating the rate of poor outcomes among miscellaneous elective surgical patients with severe comorbidities.DesignA retrospective cohort study was carried out.SettingUniversity hospital.PatientsSurgical patients with severe comorbidities.InterventionThe outcomes of 1218 surgical patients treated in intensive care units (ICUs) and postsurgical wards (ICU group vs. non-ICU group) were reviewed for poor outcomes (i.e., no discharge or death). A propensity score analysis was used to generate 248 matched pairs of ICU-admitted patients and controls.Variables Of InterestPoor outcome rates on postoperative day 90 and mortality on postoperative days 30 and 90.ResultsNo significant between-group differences were observed in terms of poor outcomes on postoperative day 90 [ICU vs. non-ICU: 33/248 (13%) vs. 28/248 (11%), respectively; ICU odds ratio (OR): 1.19, 95% confidence interval (CI), 0.71-2.01, p=0.596] or in between-group differences in terms of mortality on postoperative days 30 and 90 [ICU vs. non-ICU: 4/248 (1.6%) vs. 2/248 (0.8%) on postoperative day 30 and 5/248 (2.0%) vs. 3/248 (1.2%) on day 90, respectively; ICU OR (95% CI), 2.00 (0.37-10.9) and 1.67 (0.40-6.97) for postoperative 30- and 90-day mortality, respectively (p=0.683 and 0.724)]. Low preoperative body weight was negatively correlated to patient outcomes [OR (95% CI): 0.82/10kg (0.70-0.97), p=0.019], whereas regional analgesia combined with general anesthesia was positively correlated to patient outcomes [OR (95% CI): 0.39 (0.69-0.96), p=0.006]. Extra ICU admission was correlated to poor patient outcomes [OR (95% CI): 4.18 (2.23-7.81), p < 0.0001].ConclusionsPostoperative ICU admission failed to demonstrate any meaningful benefits in patients with severe comorbidities undergoing miscellaneous elective surgeries.Copyright © 2019 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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