Audit of postoperative surgical intensive care unit admissions (original) (raw)

Indian Journal of Critical Care Medicine

IntroductIon Medical audit is the "methodical, critical study of the quality of healthcare, the procedures used for patient management, the use of resources, and the resulting outcome and quality of human life." [1] Medical research related to the assessment of perioperative risk factors and it's correlation with the Surgical Intensive Care Unit (SICU) outcomes is limited; hence, an audit would potentially reveal additional new information, contribute to improve intensive-care outcomes, and resource utilization, thereby reducing the economic burden on the patient and hospital. Over 40% of SICU admissions are postoperative. [2-4] Postoperative intensive care is necessitated by anticipated or unpredicted complications related to anesthesia, surgery, or underlying illnesses unmasked during surgery. The complex interaction between the surgery performed, preexisting comorbidities and perioperative events determine the postoperative outcomes. [5] Early identification of indicators predicting postoperative adverse events, such as longer hospital stay, disability, and death, would prevent unfavorable consequences. [6,7] The present audit was conducted to recognize the causes of postoperative SICU admissions, to identify accountable peri-operative factors, and to determine the outcomes in terms of mortality, morbidity, SICU stay, and discharge. subject and Methods Patient and settings A prospective, observational study was conducted at a 1500-bedded tertiary care Government University Hospital in Western India during the period October 2014 to January 2016, after obtaining prior approval of the Institutional Ethics Committee. Out of the 257 postoperative patients Objective: The objective of this study was to conduct an audit of Surgical Intensive Care Unit (SICU) for identifying the admission risk factors and evaluating the outcomes of postoperative surgical patients. Design: This was a prospective, observational study. Setting: This study was conducted at SICU of a 1500-bedded tertiary care university hospital in Western India. Subject and Methods: Two hundred and forty patients admitted to the SICU postoperatively over a period of 15 months. Results: Planned and unplanned postoperative SICU admission rate was 4.45% and 0.09% of the 5284 patients operated. Indications for planned admissions included preoperative medical illnesses, anticipated blood loss, and anticipated mechanical ventilation while unpredicted intraoperative hypotension was the principal cause of unplanned admittance. Univariate analysis for two groups of the American Society of Anesthesiologists (ASA) physical status indicated that advanced age, high American College of Cardiology/American Heart Association (ACC/AHA) surgical risk, emergency surgery, planned admissions, and mortality were related to high ASA class. Analysis for ACC/AHA surgical risk showed association of high ACC/AHA surgical risk with advanced age, male gender, high ASA physical status, emergency surgery, planned admissions, and mortality. High mortality was observed in patients with SICU stay of >7 days (75.86%) and readmitted cases (72.73%). Conclusion: The need for postoperative critical care is significantly higher in males, elderly, patients with poor preoperative risk stratification scores, preexisting medical illness, major intraoperative hemorrhage, hypotension requiring inotropic support, perioperative respiratory problems and patients undergoing abdominal, trauma, and emergent surgeries. A larger study inclusive of other surgical subspecialties would aid in optimal decision-making for admissions to the SICU.