Patel Shaili K, Kacheriwala Samir M, Duttaroy Dipesh D
Department of Surgery, Medical College Baroda, Sir Sayajirao General Hospital, Vadodara, Gujarat, India.
Indian J Crit Care Med. 2018 Jan;22(1):10-15. doi: 10.4103/ijccm.IJCCM_387_17.
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.
This was a prospective, observational study.
This study was conducted at SICU of a 1500-bedded tertiary care university hospital in Western India.
Two hundred and forty patients admitted to the SICU postoperatively over a period of 15 months.
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%).
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.
本研究的目的是对外科重症监护病房（SICU）进行审核，以确定入院风险因素并评估术后外科患者的结局。
这是一项前瞻性观察性研究。
本研究在印度西部一家拥有1500张床位的三级护理大学医院的SICU进行。
15个月内240例术后入住SICU的患者。
在5284例接受手术的患者中，计划内和计划外术后SICU入住率分别为4.45%和0.09%。计划内入院的指征包括术前内科疾病、预期失血量和预期机械通气，而术中意外低血压是计划外入院的主要原因。对两组美国麻醉医师协会（ASA）身体状况进行单因素分析表明，高龄、高美国心脏病学会/美国心脏协会（ACC/AHA）手术风险、急诊手术、计划内入院和死亡率与高ASA分级相关。对ACC/AHA手术风险的分析显示，高ACC/AHA手术风险与高龄、男性、高ASA身体状况、急诊手术、计划内入院和死亡率相关。SICU住院时间>7天的患者（75.86%）和再次入院患者（72.73%）的死亡率较高。
男性、老年人、术前风险分层评分较差、有基础内科疾病、术中大出血、需要血管活性药物支持的低血压、围手术期呼吸问题以及接受腹部、创伤和急诊手术的患者术后重症监护需求明显更高。纳入其他外科亚专业的更大规模研究将有助于SICU入院的最佳决策。
