Benefit of Elective Intensive Care Admission After Certain Operations

The authors should be congratulated for attempting to shed light on the cost/benefit issue of routine short-term elective ICU admissions following certain types of major surgery. I emphasize the word “attempting” because even the authors admit that their conclusions must be accepted with caution, as they are based on highly subjective data. Their criteria for grading both the problem severity and patient benefit are, by necessity, biased by their specific outlook and the unique circumstances existing in their hospital, which may be significantly different from those in the medical center of any specific reader of this report. Many factors, such as operating room conditions and availability of monitoring equipment, the quality of the various surgical and anesthetic services, the availability and quality of recovery room services, as well as the existing conditions in the surgical wards, all have significant influence on the ultimate decision, in any one hospital, as to the advisability of routine ICU admission after various major surgical procedures. Additionally, of course, factors such as the preoperative condition of the patients (i.e., existing preoperative illnesses) and their intraoperative course, were not considered in this study. Thus, readers of this report should be encouraged to use the authors' protocol for similar studies in their own institutions. Such comparative studies, among hospitals, may help identify weak links in personnel, equipment, geographic structure, or administrative procedures in any one hospital. Projecting from the authors' conclusions, based on the experiences of the Massachusetts General Hospital, to any other hospital, however, may be seriously misleading.