Evaluation of Post-operative intensive care unit admissions in Elective Surgical Procedures.

Abstract

BACKGROUND:      Postoperatively patients are admitted to ICU for multiple reasons. ICU admissions for elective surgeries are planned pre-operatively. Some admissions are not anticipated pre-operatively, but intra-operative course determines changes in post-operative care.

OBJECTIVE:   The aim of study was to audit ICU admissions of elective surgeries, indications of admissions, ICU course and outcome of these admissions.

STUDY DESIGN:     An Observational Study.

PARTICIPANTS:      287 patients including 252 patients as planned for ICU admission but only 174 were shifted and 35 were unplanned.

METHODS: This study was a hospital based prospective observational study conducted over a period of two years. Adult patients undergoing elective surgeries and who were anticipated for post-operative ICU care were included. Patients not anticipated for ICU care but because of any event during intra-operative period were also included in the study. Pre-operative and intra-operative indications of admission, duration, complications and outcome of patients in ICU was monitored and noted.

RESULTS:   A total of 287 patients were studied. 252 patients were planned for post-operative ICU care, out of which only 175(69.4%) patients were shifted to ICU. 35 patients were unplanned ICU admissions. 104(36.23%) patients has multiple co-morbidities and 56 (19.51%) had no co-morbidity. 190(66.20%) patients were ASA II. Majority of surgeries were major abdominal procedures (58.19%), followed by urological and gynecological surgeries. 26.60% patients were shifted to ICU for monitoring purpose. Major reason of unanticipated ICU admission was intra-operative desaturation. 140(48.78%) patients had an ICU stay of less than 24 hours. Complications occurred in 8 patients. 6 patients died, out of which 5 were unanticipated admissions. Main cause of mortality was intra-operative blood loss.

CONCLUSIONS:      A significant proportion of patients were planned for ICU care, mostly on the basis of nature of surgery, but either did not need post-operative ICU care or were more admitted for monitoring only. However unplanned ICU admissions showed mortality, reemphasizing the need of preparedness on the part of  ICU for unpredictable intra-operative course.

IMPLICATIONS:      Results help in identifying the patients and causes for post-operative ICU admission thus decrease the risk of death.