Ohbe Hiroyuki, Matsui Hiroki, Kumazawa Ryosuke, Yasunaga Hideo
From the Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (HO, HM, RK, HY).
Eur J Anaesthesiol. 2022 May 1;39(5):436-444. doi: 10.1097/EJA.0000000000001612. Epub 2021 Oct 11.
Whether the routine use of the ICU after major elective surgery improves postoperative outcomes is not well established.
To describe the association between use of postoperative ICU admission and clinical outcomes for patients undergoing major elective surgery.
Observational study.
Nationwide inpatient database in Japan, July 2010 to March 2018.
Patients undergoing one of 15 major elective orthopaedic, gastrointestinal, neurological, thoracic or cardiovascular surgical procedures.
ICU admission on the day of surgery. ICU was defined as a separate unit providing critical care services with around-the-clock physician staffing and nursing, the equipment necessary for critical care and a nurse-to-patient ratio at least one to two.
In-hospital mortality. Patient-level and hospital-level analyses were performed.
Overall, 2 011 265 patients from 1524 hospitals were assessed. The cohort size ranged from 38 547 patients in 467 hospitals for surgical clipping for cerebral aneurysms to 308 952 patients in 599 hospitals for spinal fixation, laminectomy or laminoplasty. In the patient-level analyses, there were no significant mortality differences among patients undergoing the 12 major noncardiovascular surgical procedures, whereas postoperative ICU admission was associated with trends towards lower in-hospital mortality among patients undergoing coronary artery bypass grafting, risk difference -1.0% (95% CI -1.8 to -0.1) open aortic aneurysm repair, risk difference -0.6% (95% CI -1.3 to 0.1), and heart valve replacement, risk difference -0.7% (95% CI - 1.6 to 0.1). In the hospital-level analyses, similar to the results of the patient-level analyses, a higher proportion of postoperative ICU admission at hospital level was associated with trends toward lower in-hospital mortality for patients undergoing the three cardiovascular surgical procedures.
This nationwide observational study showed that postoperative ICU admission was associated with improved survival outcomes among patients undergoing three types of cardiac surgery but not among patients undergoing low-risk elective surgery.
大型择期手术后常规入住重症监护病房（ICU）是否能改善术后结局尚未明确。
描述大型择期手术患者术后入住ICU与临床结局之间的关联。
观察性研究。
2010年7月至2018年3月日本全国住院患者数据库。
接受15种大型择期骨科、胃肠道、神经科、胸科或心血管外科手术之一的患者。
手术当天入住ICU。ICU被定义为一个独立的单元，提供重症监护服务，有全天候的医生配备和护理、重症监护所需的设备以及至少1:2的护士与患者比例。
住院死亡率。进行了患者层面和医院层面的分析。
总体而言，对来自1524家医院的2011265名患者进行了评估。队列规模从467家医院的38547例脑动脉瘤手术夹闭患者到599家医院的308952例脊柱固定、椎板切除术或椎板成形术患者不等。在患者层面的分析中，接受12种主要非心血管外科手术的患者之间死亡率无显著差异，而术后入住ICU与冠状动脉搭桥术患者住院死亡率降低趋势相关，风险差异为-1.0%（95%CI -1.8至-0.1）；开放性主动脉瘤修复术患者，风险差异为-0.6%（95%CI -1.3至0.1）；心脏瓣膜置换术患者，风险差异为-0.7%（95%CI -1.6至0.1）。在医院层面的分析中，与患者层面的分析结果相似，医院层面术后入住ICU比例较高与接受三种心血管外科手术的患者住院死亡率降低趋势相关。
这项全国性观察性研究表明，术后入住ICU与三种心脏手术患者的生存结局改善相关，但与低风险择期手术患者无关。
