Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Autor: T. Yang, T. Pitts-Tucker, Daron Smith, S. Suresh, A.A. Khetarpal, C. Brathwaite-Shirley, Justine Davies, Sayinthen Vivekanantham, A. A. Adebayo, T. Sorah, N. Yim, H.R. Jackson, Salim Tayeh, R.H. Bremner, A. Piquet, L. Higgs, R. Yuen, P. Fergurson, N.K. Sim, A. Hibberd, A. Mehdi, N. Moody, D. Maru, C. Joyner, I. Hindle Fisher, Vartan Balian, N. Wetherall, Siyin Liu, P.N. Phan, S. Mallick, C. Lek, B. Oremule, S. Nelaj, M. Williams, Maqsood Qamar, A. Menon, M. Mohamud, H. Cheema, C. Chan, H.M. Omer, S.J. Cole, E. Craig, K.E. Leslie, S.S. Talukdar, R.B.S. Holliday, J. Heskin, A. Cody, Syed Shumon, S. McAleer, S. Abburu, P. Deekonda, S.F. Ashraf, R. Bose, AE Cotton, C. McGowan, S. Rashid, K. Theodoropoulou, A. MacAskill, Vishal Narwani, R. Maamari, S. Stokes, L.N. Harris, Peng Yong Sim, Evie Gardner, Leo Ng, N. Chandan, J.W. Lockey, M. Acres, H. Jhala, M.L. Kwan, A. Abdulmajid, A.E. Cardwell, P. Buakuma, C.P. Keane, M. Ahmed, N.J. Chilvers, E. Semple, J. Meek, A.K. Clarke, K. Koysombat, A. Hague, E.J.H. Turner, N. Keelty, P. Karunakaran, K.D. Clement, Mansoor Khan, Y. Cao, O. Prys-Jones, S.L. Walsh, C.N. McKerr, Sanjay Shah, S. Peroos, A. Dhanji, Joseph M. Norris, Neil Smith, M. Lakhani, M. Wijesekera, M. Bhatti, Midhun Mohan, C.Y. Luk, M. Elkawafi, S. Wadanamby, Jameel Mushtaq, Jonathan C. M. Wan, A. Ghaffar, M. Siddiqui, S. Naqib, Michaeline Kelly, J.W. Duncumb, F. Hughes, H.E.M. Jordan, R. Callan, G. Hung, C.F. Brewer, E.M. Ruiz, A. Higgins, C. Horst, C. Roberts, S. Kanabar, C. Wall, A.M. Buchan, A. Luhishi, R.P. Watson, D. Xylas, A. McBride, A. Bell, G. Heppenstall-Harris, A. Pericleous, Akanksha Chhabra, N. Hitchen, P. Raut, Shahzada Ahmed, M. Mirza, C.H. Archer, G. Russell, C.T. Francescon, D.T. Robertson, N. Gardiner, K. Cheng, A. Mishra, E. Webb, L. Rothwell, Dee A. Carter, V. Gupta, M. Johnstone, M.E. Kelly, R.D.C. Moon, E. Woin, K. Nadanakumaran, U. White, J. Empey, F. Bulley, R. Morley, G. Charalambous, L. Turner, S. Angelov, D. Coffey, S. Hartley, S. Pronin, E. Seager, R.K. Varma, Sharifullah Khan, S.B. Husnoo, R.K. Sethi, H.M. Chang, A. Duffy, Hew D.T. Torrance, P. Cunha, L. Kimani, W. Din, E.G. Heywood, C. O'Connell, D. Wylam, L. Anderson, N. Ahern, A.J. Trist, D. Burke, A. He, M. Sundar-Singh, A. Odeleye, G. Kumaran, N.L. Salloum, T.M. Brooks, A.S. Lynch, R. Debenham, Howard Gardner, M. Nielsen, M. Das, G. Bingham, S. Qureshi, Aditya Borakati, J. Wylie, Z. Kazmi, J.H. Park, P. Gill, A.R. Craig, M. Chen, Jonathan Wild, S.J. Lim, K.P. Choo, G. Culleton, G. Deas, E.Y. Chua, D. Vanniasegaram, A.H. Amphlett, N. Rajan, J.H. Chen, M. Hameed, Paul Ziprin, C. Toale, D. Gold, N. Keane, Jacob H Matthews, E. Palkhi, Nick Watson, C.M. Hewitt, A. Yousif, Faheem Ahmed, D. Wilkinson, John Mason, C. Reeder, R. Sagar, Deirdre A. Collins, S. Sandhu, S. Singh, J. Herron, A.Y.L. Ng, K. Brennan, K.A. Hoban, V. Navayogaarajah, A.S. Jawad, J.Y.L. Low, Julian R. Johnston, J. Wye, Inge Bernstein, John Parkin, A.D. Henson, Y.H. Soo, C. 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Rok vydání: 2019
Předmět:
Zdroj: British Journal of Anaesthesia. 122:42-50
ISSN: 0007-0912
DOI: 10.1016/j.bja.2018.07.029
Popis: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.
Databáze: OpenAIRE