Is postoperative ICU care needed for high-risk patients after major elective surgery?

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Introduction

Patients are frequently admitted to ICU following elective surgery either because of surgery-specific or patient-specific risk. However, ICU beds are expensive and not always available. We assessed whether there were significant differences in outcome between patients admitted to an ICU and a similar group of patients managed in general surgical wards.

Methods

All patients undergoing elective surgery over a 17-month period and for whom a place in ICU was requested were included in this prospective study. The anesthetic and surgical departments were not made aware of the study. Following surgery, patients were either admitted to ICU if a bed was available (group 1, n=97) or transferred to the general surgical wards after a mean stay of 1.9+3.7 h in the recovery room (group 2, n=47). We recorded preoperative factors (demographics, reason for admission, type of procedure, medical history, hemoglobin, serum creatinine, ASA, NYHA), intraoperative factors (type of anesthesia, intraoperative complications, units of blood transfused, length of surgery) and postoperative factors (duration of ventilation, APACHE II, TISS scores). Outcome variables were the occurrence of postoperative complications, duration of hospitalization and 28-day mortality.

Results

See Table.

Conclusion

We found no difference in three outcome variables in high-risk patients who were either admitted to the ICU or treated in a general surgical ward. Criteria for ICU admission need to be reassessed in these patients.

Table