de intensivist

Teaser: Een verlengde IC opname wordt geassocieerd met slechtere uitkomsten. Dit retrospectieve cohortonderzoek identificeert preoperatieve parameters die een verlengd verblijf op IC na electieve grote chirurgie voorspellen. Na logistische regressie analyse zijn onder andere multimorbiditeit, polyfarmacie en gastro-intestinale ingrepen geassocieerd met een verlengde IC opname. De aanwezigheid van deze parameters zou aanleiding kunnen vormen voor een multidisciplinaire preoperatieve evaluatie. 

Background: Increasing numbers of high risk and older patients undergo major surgery, some of which require postoperative ICU care, either planned or unforeseen. Most patients leave the ICU within 48 hours. Though, some patients have prolonged ICU admission or require readmission after discharge, which is associated with poor outcomes.^1,2 Therefore, identification of patients at high risk of prolonged ICU admission is pivotal in order to aid decision making on the benefit versus burden of a surgical procedure in high-risk patients. The aim of the present study was to determine preoperative predictors of prolonged ICU stay.

Methods: This retrospective single centre cohort study included patients who underwent major elective surgery and who required postoperative ICU or PACU admission in 2019 at the University Medical Center Utrecht. Patients were excluded when they underwent lung- or heart transplantation or assist device cardiac surgery. Also patients in need of chronic mechanical ventilation or who objected to reuse of data in scientific research were excluded.

The primary outcome was prolonged postoperative ICU stay, defined as >48 hours ICU admission after surgery. Secondary outcomes were unexpected postoperative ICU admission at any time during hospitalization and 30-day mortality. Logistic regression analysis was used to identify predictors.

Results: In total 798 patients were included. Most patients were admitted after elective cardiothoracic surgery (n=496 (62%)), oncological surgery (n=102 (13%)) and neurosurgery (n=102 (15%)) (Table 1). Median length of ICU stay was 22 hours (IQR 19-59) and median length of hospital stay was 175 hours (IQR 140-286). 93 patients (12%) were admitted on the ICU >48 hours.

Univariable analysis identified the revised cardiac risk index (RCRI), polypharmacy, preoperative hemoglobin, > 4 comorbidities, cerebral vascular accident (CVA), active alcohol drinking, cancer, obstructive sleep apnea (OSA) and gastrointestinal surgery as predictors of prolonged ICU stay (Table 2).

In a multivariable model only polypharmacy, OSA and gastrointestinal surgery remained independent predictors.

Conclusion: In conclusion, this study identified predictors of prolonged ICU stay after elective major surgery. In patients with one or more predictors, extensive multidisciplinary preoperative evaluation may be considered.