Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 7/2017

01-07-2017 | Original

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

Authors: Brennan C. Kahan, Desponia Koulenti, Kostoula Arvaniti, Vanessa Beavis, Douglas Campbell, Matthew Chan, Rui Moreno, Rupert M. Pearse, The International Surgical Outcomes Study (ISOS) group

Published in: Intensive Care Medicine | Issue 7/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
2.
Weiser TG, Regenbogen SE, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, Gawande AA (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144CrossRefPubMed
3.
Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel M, Uribe-Leitz T, Fu R, Azad T, Chao TE, Berry WR, Gawande AA (2015) Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet 385(Suppl 2):S11CrossRefPubMed
4.
Alkire BC, Raykar NP, Shrime MG, Weiser TG, Bickler SW, Rose JA, Nutt CT, Greenberg SL, Kotagal M, Riesel JN, Esquivel M, Uribe-Leitz T, Molina G, Roy N, Meara JG, Farmer PE (2015) Global access to surgical care: a modelling study. Lancet Glob Health 3:e316–323CrossRefPubMedPubMedCentral
5.
Rose J, Weiser TG, Hider P, Wilson L, Gruen RL, Bickler SW (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modelling strategy for the WHO Global Health Estimate. Lancet Glob Health 3:S13–20CrossRefPubMed
6.
Ghaferi AA, Birkmeyer JD, Dimick JB (2009) Variation in hospital mortality associated with inpatient surgery. New Engl J Med 361:1368–1375CrossRefPubMed
7.
Khuri SF, Daley J, Henderson W, Hur K, Demakis J, Aust JB, Chong V, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, Irvin G 3rd, McDonald G, Passaro E Jr, Phillips L, Scamman F, Spencer J, Stremple JF (1998) The Department of Veterans Affairs’ NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg 228:491–507CrossRefPubMedPubMedCentral
8.
Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, Grounds RM, Bennett ED (2006) Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care 10:R81CrossRefPubMedPubMedCentral
9.
Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, Vallet B, Vincent JL, Hoeft A, Rhodes A, European Surgical Outcomes Study group for the trials groups of the European Society of Intensive Care Medicine and the European Society of Anaesthesiology (2012) Mortality after surgery in Europe: a 7 day cohort study. Lancet 380:1059–1065CrossRefPubMedPubMedCentral
10.
Gillies MA (2016) Intensive care utilisation and outcomes after high-risk surgery in Scotland: a population based cohort study. Brit J Anaesth. doi:10.​1093/​bja/​aew396
11.
Findlay G, Goodwin A, Protopappa K, Smith N, Mason M (2011) Knowing the risk: a review of the peri-operative care of surgical patients. National Confidential Enquiry into Patient Outcome and Death, London
12.
Jhanji S, Thomas B, Ely A, Watson D, Hinds CJ, Pearse RM (2008) Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia 63:695–700CrossRefPubMed
13.
Glance LG, Lustik SJ, Hannan EL, Osler TM, Mukamel DB, Qian F, Dick AW (2012) The surgical mortality probability model: derivation and validation of a simple risk prediction rule for noncardiac surgery. Ann Surg 255:696–702CrossRefPubMed
14.
Jencks SF, Williams MV, Coleman EA (2009) Rehospitalizations among patients in the Medicare fee-for-service program. New Engl J Med 360:1418–1428CrossRefPubMed
15.
Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FA, Boersma E (2010) Postoperative mortality in the Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology 112:1105–1115CrossRefPubMed
16.
Yu PC, Calderaro D, Gualandro DM, Marques AC, Pastana AF, Prandini JC, Caramelli B (2010) Non-cardiac surgery in developing countries: epidemiological aspects and economical opportunities—the case of Brazil. PLoS One 5:e10607CrossRefPubMedPubMedCentral
17.
Pearse RM, Holt PJ, Grocott MP (2011) Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ 343:d5759CrossRefPubMed
18.
Gillies MA, Power GS, Harrison DA, Fleming A, Cook B, Walsh TS, Pearse RM, Rowan KM (2015) Regional variation in critical care provision and outcome after high-risk surgery. Intensive Care Med 41:1809–1816CrossRefPubMed
19.
Ozdemir BA, Sinha S, Karthikesalingam A, Poloniecki JD, Pearse RM, Grocott MP, Thompson MM, Holt PJ (2016) Mortality of emergency general surgical patients and associations with hospital structures and processes. Br J Anaesth 116:54–62CrossRefPubMed
20.
Wunsch H, Gershengorn HB, Cooke CR, Guerra C, Angus DC, Rowe JW, Li G (2016) Use of intensive care services for medicare beneficiaries undergoing major surgical procedures. Anesthesiology 124(4):899–907CrossRefPubMedPubMedCentral
21.
Gillies MA, Pearse RM (2016) Intensive care after high-risk surgery: what’s in a name? Anesthesiology 124(4):761–762CrossRefPubMed
22.
International Surgical Outcomes Study Group (2016) Global patient outcomes after elective surgery: prospective cohort study in 27 low, middle and high income countries. Br J Anaesth 117(5):601–609CrossRef
23.
Jammer I, Wickboldt N, Sander M, Smith A, Schultz MJ, Pelosi P, Leva B, Rhodes A, Hoeft A, Walder B, Chew MS, Pearse RM (2015) Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures. Eur J Anaesthesiol 32(2):88–105
24.
Rabe-Hesketh S, Skrondal A (2012) Multilevel and longitudinal modeling using stata. Stata, Texas
25.
Harrell FE (2001) Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Springer, New YorkCrossRef
26.
27.
James S, Jhanji S, Smith A, O’Brien G, Fitzgibbon M, Pearse RM (2014) Comparison of the prognostic accuracy of scoring systems, cardiopulmonary exercise testing, and plasma biomarkers: a single-centre observational pilot study. Br J Anaesth 112:491–497CrossRefPubMed
28.
Griffiths P, Ball J, Drennan J, James L, Jones J, Recio-Saucedo A, Simon M (2014) The association between patient safety outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements. National Institute for Health and Care Excellence, London
29.
30.
Blegen MA, Goode CJ, Spetz J, Vaughn T, Park SH (2011) Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Med Care 49:406–414CrossRefPubMed
31.
Cho SH, Ketefian S, Barkauskas VH, Smith DG (2003) The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs. Nurs Res 52:71–79CrossRefPubMed
32.
McGillis Hall L, Doran D, Pink GH (2004) Nurse staffing models, nursing hours, and patient safety outcomes. J Nurs Adm 34:41–45CrossRefPubMed
33.
Silber JH, Rosenbaum PR, McHugh MD, Ludwig JM, Smith HL, Niknam BA, Even-Shoshan O, Fleisher LA, Kelz RR, Aiken LH (2016) Comparison of the value of nursing work environments in hospitals across different levels of patient risk. JAMA Surg 151:527–536CrossRefPubMedPubMedCentral
Metadata
Title
Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries
Authors
Brennan C. Kahan
Desponia Koulenti
Kostoula Arvaniti
Vanessa Beavis
Douglas Campbell
Matthew Chan
Rui Moreno
Rupert M. Pearse
The International Surgical Outcomes Study (ISOS) group
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 7/2017
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4633-8

Other articles of this Issue 7/2017

Intensive Care Medicine 7/2017 Go to the issue

Editorial

Do we really need postoperative ICU management after elective surgery? No, not any more!

Correspondence

Video laryngoscopy for ICU intubation: should it be standard of care?

Original

Appropriate endpoints for evaluation of new antibiotic therapies for severe infections: a perspective from COMBACTE’s STAT-Net

Review

The role of infection models and PK/PD modelling for optimising care of critically ill patients with severe infections

Original

Association between mRNA expression of CD74 and IL10 and risk of ICU-acquired infections: a multicenter cohort study

Imaging in Intensive Care Medicine

Blue nose syndrome in acquired thrombotic thrombocytopenic purpura