Predicting major surgical complications in intensive care units and in-hospital mortality of patients from the emergency room: A retrospective single-center study

Objective Major surgical complications (MSCs) are a leading cause of morbidity and mortality in patients requiring surgical intensive care, especially those admitted from the emergency room (ER). The characteristics and predictors of MSCs in this high-risk population remain poorly defined. The objective is to identify the incidence and independent predictors of MSCs and in-hospital mortality among adult patients admitted to the surgical intensive care unit (SICU) from the ER after emergency surgery. Methods We conducted a retrospective, observational cohort study of 322 adult patients admitted to the SICU from the ER after emergency surgery at a tertiary hospital in Taiwan between January 2022 and February 2023. Postoperative complications were graded using the Clavien–Dindo classification. Patients were divided into minor (Grades I–IIIa) and major (Grades IIIb–V) complication groups. Multivariate logistic regression identified predictors of MSCs and in-hospital mortality. Results MSCs occurred in 20.8% of patients. In-hospital mortality was 14.0%. Independent predictors of MSCs included higher Acute Physiology and Chronic Health Evaluation II scores, presence of shock at intensive care unit (ICU) admission, biliary tree and soft tissue surgery, an American Society of Anesthesiologists score ≥4, and prolonged mechanical ventilation. These factors also independently predicted mortality. Patients with MSCs had higher in-hospital mortality (47.8% vs. 5.1%, p < 0.01), longer ICU stays (15.3 vs. 5.8 days), and higher hospital costs ($21,599 vs. $9607; p < 0.001). Conclusions Emergency surgery patients admitted to SICU from the ER face a high risk of major complications and death. Physiological severity, surgical complexity, and pre-ICU instability are key predictors. Early identification of these factors can guide risk mitigation strategies.