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

Publication ,  Journal Article
Kahan, BC; Koulenti, D; Arvaniti, K; Beavis, V; Campbell, D; Chan, M; Moreno, R; Pearse, RM; International Surgical Outcomes Study (ISOS) group,
Published in: Intensive Care Med
July 2017

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.

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Published In

Intensive Care Med

DOI

EISSN

1432-1238

Publication Date

July 2017

Volume

43

Issue

7

Start / End Page

971 / 979

Location

United States

Related Subject Headings

  • Prospective Studies
  • Postoperative Period
  • Perioperative Care
  • Middle Aged
  • Male
  • Logistic Models
  • Length of Stay
  • Intensive Care Units
  • Humans
  • Hospitalization
 

Citation

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Kahan, B. C., Koulenti, D., Arvaniti, K., Beavis, V., Campbell, D., Chan, M., … International Surgical Outcomes Study (ISOS) group, . (2017). Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med, 43(7), 971–979. https://doi.org/10.1007/s00134-016-4633-8
Kahan, Brennan C., Desponia Koulenti, Kostoula Arvaniti, Vanessa Beavis, Douglas Campbell, Matthew Chan, Rui Moreno, Rupert M. Pearse, and Rupert M. International Surgical Outcomes Study (ISOS) group. “Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries.Intensive Care Med 43, no. 7 (July 2017): 971–79. https://doi.org/10.1007/s00134-016-4633-8.
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 Med. 2017 Jul;43(7):971–9.
Kahan, Brennan C., et al. “Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries.Intensive Care Med, vol. 43, no. 7, July 2017, pp. 971–79. Pubmed, doi:10.1007/s00134-016-4633-8.
Kahan BC, Koulenti D, Arvaniti K, Beavis V, Campbell D, Chan M, Moreno R, Pearse RM, International Surgical Outcomes Study (ISOS) group. Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med. 2017 Jul;43(7):971–979.
Journal cover image

Published In

Intensive Care Med

DOI

EISSN

1432-1238

Publication Date

July 2017

Volume

43

Issue

7

Start / End Page

971 / 979

Location

United States

Related Subject Headings

  • Prospective Studies
  • Postoperative Period
  • Perioperative Care
  • Middle Aged
  • Male
  • Logistic Models
  • Length of Stay
  • Intensive Care Units
  • Humans
  • Hospitalization