Admission to intensive care unit after elective surgery: an audit in a tertiary hospital

Abstract

Unplanned admission to intensive care unit (ICU) after elective surgery increases workload of this department and reflects processes which may negatively affect postoperative outcomes. Aim of this study was to determine the features of unplanned hospitalization to ICU after elective surgeries in Lithuanian University of Health Sciences Kauno Klinikos and to determine the factors associated with patient outcomes after these surgeries. Methods:A retrospective analysis of medical records of patients, who were hospitalized to ICU after elective surgery in Lithuanian University of Health Sciences Kauno Klinikos from 2014 to 2015. Procedures with routine postoperative admission to ICU were excluded. Results:120 patients entered the ICU after elective surgery. During the study period 72 (60%) patients were transferred to ICU due to respiratory failure, 6 (5.0%) due to blood loss, 5 (4.2%) due to respiratory failure and blood loss, 1 (0.8%) due to cholinesterase deficiency, 3 (2.5%) due to multiple organ dysfunction syndrome, 30 (25.0%) for postanesthesia care, 1 (0.8 %) due to myocardial infarction during surgery, 1 (0.8%) due to bradycardia, 1 (0.8%) due to anaphylactic reactions. Mean duration of ICU stay was 45.61±93.62 hours. The rate of in-hospital deaths was 7 (5.8%). Length of stay in ICU time depended on the reason of ICU admission (χ2(8)=16.962, p=0.031). In-hospital mortality depended on the following factors: blood product transfusion during surgery (χ2(1)=4.014, p=0.045), vasoactive agents during surgery (χ2(1)=3.959, p=0.047), ASA score (χ2(3)=18.352, p=0.000) and area of surgery (χ2(2)=9.228, p=0.010. Conclusion:The most common reason of ICU admission was respiratory failure. We found that in-hospital mortality depended on blood product transfusion, vasoactive agents during surgery, ASA score and area of surgery. Further prospective studies are needed to determine the cause of these risk factors.