Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

B.C. Kahan, D. Koulenti, K. Arvaniti, V. Beavis, D. Campbell, M. Chan, R. Moreno, R.M. Pearse, R.M. Pearse, S. Beattie, P.-A. Clavien, N. Demartines, L.A. Fleisher, M. Grocott, J. Haddow, A. Hoeft, P. Holt, R. Moreno, N. Pritchard, A. RhodesD. Wijeysundera, M. Wilson, T. Ahmed, K. Everingham, R. Hewson, M. Januszewska, R.M. Pearse, M.-K. Phull, E. Lee, S. Choi, C. Chen, Y. Han, S. Yang, K. Han, C. Chen, S. Chu, C.K.E. Chung, C. Lee, Y.C. Lee, H.S. Lee, J.M. Lee, H.-M.D. Choi, C.J. Kim, S. Kim, K. Park, Y.H. Chang, J. Chang, C. Lee, G. Lee, T. Kim

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© 2017, Springer-Verlag Berlin Heidelberg and ESICM. Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%] ; adjusted OR 3.01 [2.10–5.21]; p  < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.
Original languageEnglish
JournalIntensive Care Medicine
Issue number7
Publication statusPublished - 2017


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