Advanced search
2 files | 1.54 MB

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

(2017) INTENSIVE CARE MEDICINE. 43(7). p.971-979
Author
Organization
Abstract
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.
Keywords
Critical care/utilisation, Postoperative care/methods, Postoperative care/statistics and numerical data, Surgical procedures, operative/mortality, HIGH-RISK SURGERY, MODELING STRATEGY, SURGICAL-PATIENTS, INTENSIVE-CARE, MORTALITY, POPULATION, HOSPITALS, OUTCOMES, PROGRAM

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 893.91 KB
  • (...).docx
    • full text
    • |
    • UGent only
    • |
    • Word
    • |
    • 644.24 KB

Citation

Please use this url to cite or link to this publication:

Chicago
Kahan, Brennan C, Desponia Koulenti, Kostoula Arvaniti, Vanessa Beavis, Douglas Campbell, Matthew Chan, Rui Moreno, et al. 2017. “Critical Care Admission Following Elective Surgery Was Not Associated with Survival Benefit : Prospective Analysis of Data from 27 Countries.” Intensive Care Medicine 43 (7): 971–979.
APA
Kahan, B. C., Koulenti, D., Arvaniti, K., Beavis, V., Campbell, D., Chan, M., Moreno, R., et al. (2017). Critical care admission following elective surgery was not associated with survival benefit : prospective analysis of data from 27 countries. INTENSIVE CARE MEDICINE, 43(7), 971–979.
Vancouver
1.
Kahan BC, Koulenti D, Arvaniti K, Beavis V, Campbell D, Chan M, et al. Critical care admission following elective surgery was not associated with survival benefit : prospective analysis of data from 27 countries. INTENSIVE CARE MEDICINE. 2017;43(7):971–9.
MLA
Kahan, Brennan C, Desponia Koulenti, Kostoula Arvaniti, et al. “Critical Care Admission Following Elective Surgery Was Not Associated with Survival Benefit : Prospective Analysis of Data from 27 Countries.” INTENSIVE CARE MEDICINE 43.7 (2017): 971–979. Print.
@article{8536623,
  abstract     = {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 {\textlangle} 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.},
  author       = {Kahan, Brennan C and Koulenti, Desponia and Arvaniti, Kostoula and Beavis, Vanessa and Campbell, Douglas and Chan, Matthew and Moreno, Rui and Pearse, Rupert M and International Surgical Outcomes Study (ISOS) group, the and Wouters, Patrick and De Hert, Stefan and Abeloos, Jacques and Bouchez, Stefaan and Coppens, Marc and De Baerdemaeker, Luc and DEBLAERE, ISABEL and De Bruyne, Ann and Fonck, Kristine and Heyse, Bjorn and JACOBS, TOM and Lapage, Koen and Moerman, Anneliese and NECKEBROEK, MARTINE and Parashchanka, Aliaksandra and ROELS, NATHALIE and Van Den Eynde, Nancy and Vandenheuvel, Micha{\"e}l and Van Limmen, Jurgen and Vanluchene, Ann and Vanpeteghem, Caroline and WYFFELS, PIET},
  issn         = {0342-4642},
  journal      = {INTENSIVE CARE MEDICINE},
  language     = {eng},
  number       = {7},
  pages        = {971--979},
  title        = {Critical care admission following elective surgery was not associated with survival benefit : prospective analysis of data from 27 countries},
  url          = {http://dx.doi.org/10.1007/s00134-016-4633-8},
  volume       = {43},
  year         = {2017},
}

Altmetric
View in Altmetric
Web of Science
Times cited: