Wong Kitty H F, Murigu Alex K, Buongiovanni Gianluca, Mouton Ronelle, Hinchliffe Robert J
Department of Vascular Surgery, Bristol Medical School, University of Bristol, Bristol, UK.
Postgraduate School of Vascular Surgery, Università Degli Studi di Milano, Milan, Italy.
Br J Surg. 2025 Aug 1;112(8). doi: 10.1093/bjs/znaf172.
The optimal use of ICU resources in patients undergoing vascular surgery is unclear. The aim of this systematic review was to evaluate the impact of ICU admission on clinical outcomes and costs after elective and emergency vascular surgery.
MEDLINE, Embase, the Cochrane Library, Cochrane Collaboration Central Register of Controlled Trials (CENTRAL), and trial registry databases were searched in July 2024. Studies comparing ICU care with intermediary or ward-based care for major vascular surgery patients were included.
Thirteen studies (11 elective only and 2 including emergencies) involving 157 932 patients met the inclusion criteria. ICU admission was associated with higher adjusted 30-day or in-hospital mortality (OR 4.14 (95% c.i. 1.65 to 10.41), P = 0.003; Grading of Recommendations Assessment, Development, and Evaluation (GRADE) certainty: moderate). Unadjusted analyses found ICU admission was associated with increased major adverse cardiovascular events (risk ratio (RR) 1.45 (95% c.i. 1.04 to 2.01), P = 0.030; GRADE certainty: very low), acute kidney injury (RR 1.98 (95% c.i. 1.49 to 2.63), P < 0.001; GRADE certainty: moderate), dialysis (RR 1.76 (95% c.i. 1.13 to 2.74), P = 0.010; GRADE certainty: low), readmission (RR 1.93 (95% c.i. 1.20 to 3.12), P = 0.007; GRADE certainty: moderate), and major bleeding (RR 1.37 (95% c.i. 1.03 to 1.81), P = 0.030; GRADE certainty: moderate). Respiratory failure requiring mechanical ventilation and infection were higher in patients admitted to ICU compared with ward-based care specifically. Hospital-associated costs were higher for ICU admission across all procedures.
No clear clinical benefit was associated with ICU admission after vascular surgery. This may be due to residual confounding and insufficient risk stratification.
血管外科手术患者重症监护病房（ICU）资源的最佳利用尚不清楚。本系统评价的目的是评估ICU收治对择期和急诊血管外科手术后临床结局和成本的影响。
于2024年7月检索了MEDLINE、Embase、Cochrane图书馆、Cochrane协作网对照试验中心注册库（CENTRAL）和试验注册数据库。纳入比较主要血管外科手术患者ICU护理与中间护理或病房护理的研究。
13项研究（11项仅为择期研究，2项包括急诊研究）涉及157932例患者，符合纳入标准。ICU收治与调整后的30天或住院死亡率较高相关（比值比（OR）4.14（95%置信区间1.65至10.41），P = 0.003；推荐分级评估、制定和评价（GRADE）确定性：中等）。未调整分析发现，ICU收治与主要不良心血管事件增加相关（风险比（RR）1.45（95%置信区间1.04至2.01），P = 0.030；GRADE确定性：极低）、急性肾损伤（RR 1.98（95%置信区间1.49至2.63），P < 0.001；GRADE确定性：中等）、透析（RR 1.76（95%置信区间1.13至2.74），P = 0.010；GRADE确定性：低）、再入院（RR 1.93（95%置信区间1.20至3.12），P = 0.007；GRADE确定性：中等）和大出血（RR 1.37（95%置信区间1.03至1.81），P = 0.030；GRADE确定性：中等）。与病房护理相比，入住ICU的患者需要机械通气的呼吸衰竭和感染发生率更高。所有手术中，ICU收治的医院相关成本更高。
血管外科手术后ICU收治未显示出明显的临床益处。这可能是由于残余混杂因素和风险分层不足所致。
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