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Exposure to surgery is associated with better long‐term outcomes in patients admitted to Swedish intensive care units
Author(s) -
Jawad Monir,
Baigi Amir,
Chew Michelle
Publication year - 2020
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13604
Subject(s) - medicine , intensive care unit , logistic regression , odds ratio , hazard ratio , proportional hazards model , intensive care , cohort , cohort study , emergency medicine , pediatrics , confidence interval , intensive care medicine
Background Long‐term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long‐term effects of surgical exposure prior to ICU admission. Methods Registry‐based cohort study. The adjusted effect of surgical exposure for mortality was examined using Cox regression. Secondary analysis with conditional logistic regression in a case‐control subpopulation matched for age, gender, and Simplified Acute Physiology Score III (SAPS3) was also conducted. Results 72 242 adult patients (56.9% males, median age 66 years [IQR 50‐76]), admitted to Swedish ICUs in 3‐year (2012‐2014) were followed for a median of 2026 days (IQR 1745‐2293). Cardiovascular diseases (17.5%), respiratory diseases (15.8%), trauma (11.2%), and infections (11.4%) were the leading causes for ICU admission. Mortality at longest follow‐up was 49.4%. Age; SAPS3; admissions due to malignancies, respiratory, cardiovascular and renal diseases; and transfer to another ICU were associated with increased mortality. Surgical exposure prior to ICU admission (adjusted hazard ratio [aHR] 0.90; 95% CI 0.87‐0.94; P < .001), admissions from the operation theatre (aHR 0.94; CI 0.90‐0.99; P = .022) or post‐anaesthesia care unit (aHR 0.92; CI 0.87‐0.97; P = .003) were associated with decreased mortality. Conditional logistic regression confirmed the association between surgical exposure and decreased mortality (adjusted odds ratio 0.82; CI 0.75‐0.91; P < .001). Conclusions Long‐term ICU mortality was associated with known risk factors such as age and SAPS3. Transfer to other ICUs also appeared to be a risk factor and requires further investigation. Prior surgical exposure was associated with better outcomes, a noteworthy observation given limited ICU admissions after surgery in Sweden.