Department of Anaesthesia, Critical Care and Pain Medicine
Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Br J Anaesth. 2017 Jan;118(1):123-131. doi: 10.1093/bja/aew396.
The optimal perioperative use of intensive care unit (ICU) resources is not yet defined. We sought to determine the effect of ICU admission on perioperative (30 day) and long-term mortality.
This was an observational study of all surgical patients in Scotland during 2005-7 followed up until 2012. Patient, operative, and care process factors were extracted. The primary outcome was perioperative mortality; secondary outcomes were 1 and 4 yr mortality. Multivariable regression was used to construct a risk prediction model to allow standard-risk and high-risk groups to be defined based on deciles of predicted perioperative mortality risk, and to determine the effect of ICU admission (direct from theatre; indirect after initial care on ward; no ICU admission) on outcome adjusted for confounders.
There were 572 598 patients included. The risk model performed well (c-index 0.92). Perioperative mortality occurred in 1125 (0.2%) in the standard-risk group (n=510 979) and in 3636 (6.4%) in the high-risk group (n=56 785). Patients with no ICU admission within 7 days of surgery had the lowest perioperative mortality (whole cohort 0.7%; high-risk cohort 5.3%). Indirect ICU admission was associated with a higher risk of perioperative mortality when compared with direct admission for the whole cohort (20.9 vs 12.1%; adjusted odds ratio 2.39, 95% confidence interval 2.01-2.84; P<0.01) and for high-risk patients (26.2 vs 17.8%; adjusted odds ratio 1.64, 95% confidence interval 1.37-1.96; P<0.01). Compared with direct ICU admission, indirectly admitted patients had higher severity of illness on admission, required more organ support, and had an increased duration of ICU stay.
Indirect ICU admission was associated with increased mortality and increased requirement for organ support.
UKCRN registry no. 15761.
强化医疗单位（ICU）资源的最佳围手术期使用尚未确定。我们旨在确定 ICU 入院对围手术期（30 天）和长期死亡率的影响。
这是一项针对苏格兰 2005-7 年所有手术患者的观察性研究，随访至 2012 年。提取患者、手术和护理过程因素。主要结果是围手术期死亡率；次要结果是 1 年和 4 年死亡率。多变量回归用于构建风险预测模型，以便根据围手术期死亡率预测风险的十分位数定义标准风险和高风险组，并确定 ICU 入院（直接从手术室；最初在病房护理后的间接入院；无 ICU 入院）对根据混杂因素调整的结果的影响。
共纳入 572598 例患者。风险模型表现良好（c 指数 0.92）。标准风险组（n=510979）围手术期死亡率为 1125（0.2%），高风险组（n=56785）为 3636（6.4%）。手术后 7 天内无 ICU 入院的患者围手术期死亡率最低（全队列 0.7%；高风险队列 5.3%）。与直接入院相比，间接 ICU 入院与整个队列（20.9%比 12.1%；调整后的优势比 2.39，95%置信区间 2.01-2.84；P<0.01）和高风险患者（26.2%比 17.8%；调整后的优势比 1.64，95%置信区间 1.37-1.96；P<0.01）的围手术期死亡率风险更高。与直接 ICU 入院相比，间接入院的患者入院时疾病严重程度更高，需要更多器官支持，并且 ICU 住院时间延长。
间接 ICU 入院与死亡率增加和器官支持需求增加有关。
英国临床试验注册中心注册号 15761。
