Key result
Ward admission for ICU-referred high-risk non-cardiac surgical patients is linked to ~25% MET activation.
Why the study?
Higher-risk surgical patients may not be admitted to the intensive care unit if immediately stable post-operatively, but the subsequent outcomes of this cohort are not well described.
Does admission to the regular ward instead of the intensive care unit increase the risk of Medical Emergency Team activation in high-risk non-cardiac surgery patients?
Cohort (n=60)
No
Does admission to the regular ward instead of the intensive care unit increase the risk of Medical Emergency Team activation in high-risk non-cardiac surgery patients?
Post-operative deterioration occurs frequently and early in high-risk surgical patients initially assessed as safe for ward care, suggesting a need for revised triage models.
High ward deterioration rates signal need for enhanced monitoring; hypothesis-generating for optimal ICU triage in high-risk non-cardiac surgery.
BACKGROUND: Higher-risk surgical patients may not be admitted to the intensive care unit due to stable immediate post-operative status on review. The outcomes of this cohort are not well described. Our aim was to examine the subsequent inpatient course of intensive care unit -referred but not admitted surgical patients. METHODS: All patients aged ≥18 years who were referred but not admitted for post-operative management in a tertiary metropolitan intensive care unit following non-cardiac surgery between 1/7/2017 and 30/6/2018 were eligible for inclusion in this retrospective observational cohort study. Primary outcome was Medical Emergency Team activation. Secondary outcomes included unplanned intensive care unit admission; length of stay; and 30-day mortality. Risk of serious complications and predicted length of stay were calculated using the National Surgical Quality Improvement Program scoring tool. RESULTS: Fifteen of 60 patients (25%) had a MET-call following surgery, eight (13%) patients required unplanned intensive care unit admission, with median (IQR) time to Medical Emergency Team call 9 (6-13) hours. No patients died within 30-days. There was no significant difference between mean National Surgical Quality Improvement Program predicted and actual length of stay; after adjustment, National Surgical Quality Improvement Program predicted risk of serious complications was associated with unplanned intensive care unit admission (OR [95% CI] = 1.08 [1.00-1.16], p = 0.04), although not Medical Emergency Team calls. CONCLUSIONS: Post-operative deterioration occurs frequently, and early, in a cohort of high-risk surgical patients initially assessed as being safe for ward care. Changes to current triage models for post-operative intensive care unit admission may reduce the impact of complications in this high-risk group.
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Moore et al. (2021) conducted a cohort in Post-operative non-cardiac surgery (n=60). Ward care after ICU referral was evaluated on Medical Emergency Team (MET) activation. Among high-risk non-cardiac surgery patients referred for ICU but admitted to the regular ward, 25% experienced clinical deterioration requiring Medical Emergency Team activation.
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