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Original Article
Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil
Rev Bras Ter Intensiva. 2020;32(1):17-27
Abstract
Original ArticleEpidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil
Rev Bras Ter Intensiva. 2020;32(1):17-27
DOI 10.5935/0103-507X.20200005
Views1ABSTRACT
Objective:
To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil.
Methods:
This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated.
Results:
Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval – 95%CI 3.3% – 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 – 4.0) days, and the length of hospital stay was 9.5 (5.4 – 18.6) days. The complication rate was 29.9% (95%CI 26.4 – 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 – 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio – OR = 1.02; 95%CI 1.01 – 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 – 1.25), surgical time (OR = 1.001, 95%CI 1.000 – 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 – 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 – 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 – 1.279), SOFA (OR = 1.175, 95%CI 1.069 – 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 – 6.051).
Conclusion:
Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
Keywords:BrazilIntensive care unitspostoperative carePostoperative complications/mortalitySurgical procedures, operative/epidemiologySurgical procedures, operative/mortalitySee more
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis