Key result
Emergent neurologic surgery was associated with increased in-hospital mortality compared to emergent cardiovascular surgery (RR 1.86; 95% CI 1.67-2.07; P<0.001).
Why the study?
The effect of organ system surgical intervention on intensive care unit mortality was unknown in an aging population undergoing surgery despite comorbidities.
Does the organ system of surgical intervention affect in-hospital mortality in critically ill surgical ICU patients?
Cohort (n=97,968)
Does the organ system of surgical intervention affect in-hospital mortality in critically ill surgical ICU patients?
The specific organ system involved in surgical intervention significantly impacts in-hospital mortality risk for ICU patients, a factor not currently accounted for in prognostic scoring systems.
Answers are grounded in this paper and cite their sources.
Certain organ-system surgeries may elevate ICU mortality risk; leaves open need for prospective validation of targeted perioperative strategies.
Background The critical illness burden in the United States is growing with an aging population obtaining surgical intervention despite age-related comorbidities. The effect of organ system surgical intervention on intensive care units (ICUs) mortality is unknown. Methods We performed an 8-year retrospective analysis of surgical ICU patients. Poisson regression analysis was performed assessing the relative risk of in-hospital mortality based on surgical intervention. Results Of 468 000 ICU patients included, 97 968 (20.9%) were surgical admissions and 97 859 (99.9%) had complete outcomes data. Nonsurvivors were older (68.8 ± 15.4 vs. 62.7 ± 15.8 years, P < .001) with higher Acute Physiology, Age, Chronic Health Evaluation (APACHE) III Scores (81.4 ± 33.6 vs. 46.7 ± 20.1, P < .001. Patients with gastrointestinal (GI) (n = 1,558, 7.8%), musculoskeletal (n = 277, 5.5%), and neurological (n = 884, 4.6%) system operations had the highest mortality. Upon Poisson regression model, patients undergoing emergent operative interventions on the neurologic system (RR 1.86, 95% CI 1.67-2.07, P < .001) had increased relative risk of mortality when compared to emergent operative interventions on the cardiovascular system after controlling for pertinent covariates. Elective operative interventions on the respiratory (RR 2.39, 95% CI 2.03-2.80, P < .001), GI (RR 2.34, 95% CI 2.10-2.61, P < .001), and skin and soft tissue (RR 2.26, 95% CI 1.77-2.89, P < .001) systems had increased risk of mortality when compared to elective cardiovascular system surgery after controlling for pertinent covariates. Conclusion We found significant differences in the risk of mortality based on organ system of operative intervention. The prognostication of critically ill patients undergoing surgical intervention is currently not accounted for in prognostic scoring systems.
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Shchatsko et al. (2020) conducted a cohort in Critically ill surgical patients (n=97,968). Non-cardiovascular organ system surgery (e.g., neurologic, respiratory, gastrointestinal) vs. Cardiovascular system surgery was evaluated on In-hospital mortality (RR 1.86, 95% CI 1.67-2.07, p=<.001). Emergent neurologic surgery was associated with increased in-hospital mortality compared to emergent cardiovascular surgery (RR 1.86; 95% CI 1.67-2.07; P<0.001).
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