Department of Anaesthesiology and Pain Medicine, Seoul National University Bundang Hospital, 166, Gumi-ro, Bundang-gu, Seongnam 463-707 South Korea.
Medical Research Collaborating Centre, Seoul National University Bundang Hospital, South Korea.
Anaesth Crit Care Pain Med. 2019 Jun;38(3):259-263. doi: 10.1016/j.accpm.2018.09.010. Epub 2018 Oct 17.
This study aimed to investigate the association between postoperative surgical Intensive Care Unit (ICU) admission during a time when there was intensivist coverage and 30-day mortality after ICU admission.
This was a retrospective observational study in a tertiary care academic hospital ICU, with daytime intensivist coverage. We collected the electronic medical records for all patients who were admitted to the postoperative ICU after undergoing a surgery between January 1, 2007 and December 31, 2016. The primary outcome was to examine the differences in 30-day mortality after ICU admission according to ICU admission during times of intensivist or non-intensivist coverage.
Overall, 13,906 patients were included (6634 [47.7%] patients were admitted with intensivist coverage, and 7272 [52.3%] patients without intensivist coverage). After performing propensity Score matching, 10,708 patients (5354 patients in each group) were analysed. In the matched cohorts, 30-day mortality after postoperative ICU admission in the group without intensivist coverage was higher than that with intensivist coverage [30-day mortality, 251/5354 (4.7%) and 173/5354 (3.2%) in the groups without and with intensivist coverage, respectively, P < 0.001]. Post-operative ICU admission in the group without intensivist coverage was associated with an increased risk of 30-day mortality (risk ratio: 1.45, 95% confidence interval: 1.20-1.75, P < 0.001).
This study showed an increase in post-operative 30-day mortality, and length of hospital and ICU stay for surgical ICU admission among those without intensivist coverage.
本研究旨在探讨在有 intensivist 覆盖的情况下，术后进入重症监护病房（ICU）与 ICU 入住后 30 天死亡率之间的关联。
这是一项在一家三级护理学术医院 ICU 进行的回顾性观察性研究，白天有 intensivist 覆盖。我们收集了 2007 年 1 月 1 日至 2016 年 12 月 31 日期间接受手术后入住术后 ICU 的所有患者的电子病历。主要结局是根据 ICU 入住时 intensivist 或非 intensivist 覆盖情况，检查 ICU 入住后 30 天死亡率的差异。
共有 13906 名患者被纳入研究（6634 名[47.7%]患者在 intensivist 覆盖下入住 ICU，7272 名[52.3%]患者在非 intensivist 覆盖下入住 ICU）。在进行倾向评分匹配后，分析了 10708 名患者（每组 5354 名患者）。在匹配队列中，非 intensivist 覆盖组 ICU 入住后 30 天死亡率高于 intensivist 覆盖组[30 天死亡率，非 intensivist 覆盖组 3054 例（4.7%）和 intensivist 覆盖组 5354 例（3.2%），P<0.001]。非 intensivist 覆盖组 ICU 入住与 30 天死亡率增加相关（风险比：1.45，95%置信区间：1.20-1.75，P<0.001）。
本研究表明，在没有 intensivist 覆盖的情况下，术后 30 天死亡率、住院时间和 ICU 入住时间增加。
