Key result
A four-variable bedside admission model discriminated continued ICU-level care requirement or death at 48 hours with an AUC of 0.820 (95% CI 0.748–0.891).
Why the study?
The ability of clinical and bedside physiological variables at ICU admission to discriminate postoperative patients who still require ICU-level care at 48 hours, and the underlying reasons for this ongoing need, required investigation.
Does a four-variable bedside clinical and physiological model at ICU admission discriminate postoperative patients who require continued ICU-level care at 48 hours or die within 48 hours?
Cohort (n=143)
No
Does a four-variable bedside clinical and physiological model at ICU admission discriminate postoperative patients who require continued ICU-level care at 48 hours or die within 48 hours?
A four-variable bedside admission model (ASA status III–V, emergency surgery, intubation, and shock index) accurately discriminates non-cardiac postoperative patients who will require continued ICU-level care or die within 48 hours (AUC 0.820), highlighting that ongoing ICU need is often driven by intensive monitoring requirements rather than new organ support.
May aid early identification of postoperative ICU needs; hypothesis-generating and requires prospective validation before practice change.
Aims: We investigated whether clinical and bedside physiological variables available at intensive care unit (ICU) admission discriminate postoperative patients who continue to require ICU-level care at 48 hours, and characterized the reasons for this need. Methods: Consecutive adults admitted to the ICU directly after operating-room surgery between January 1 and July 1, 2026 were retrospectively reviewed. The primary outcome was failure to meet at least one of five prespecified clinical domains at 48 hours, or death within 48 hours; patients remaining solely for logistical reasons were not classified as having the outcome. The primary model comprised American Society of Anesthesiologists (ASA) physical status III–V, emergency surgery, intubation at ICU admission and shock index. Results: Of 143 patients, the primary outcome occurred in 39 (27.3%). The primary model yielded an area under the receiver operating characteristic curve (AUC) of 0.820 (95% confidence interval, 0.748–0.891; optimism-corrected, 0.799). Emergency surgery, intubation at ICU admission and a higher shock index were independently associated with the outcome, and adding bedside physiology and level of support improved discrimination (ΔAUC, 0.050; p=0.017). Of the 37 patients with an ongoing requirement, 6 (16.2%) met all four organ-domain criteria and 23 (62.2%) had no early adverse event.Conclusion: A four-variable bedside admission model showed good discrimination for continued ICU-level care requirement at 48 hours or death within 48 hours. This need frequently reflected unresolved acute problems requiring intensive monitoring rather than new organ support. External validation is required.
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Ay et al. (2026) conducted a cohort in Postoperative ICU admission (n=143). Four-variable bedside ICU admission model (ASA physical status III–V, emergency surgery, intubation at ICU admission, and shock index) vs. Contextual variables alone (ASA physical status III–V and emergency surgery) was evaluated on Continued ICU-level care requirement at 48 hours (failing at least one of five prespecified clinical domains) or death within 48 hours (AUC 0.820, 95% CI 0.748-0.891, p=0.017). A four-variable bedside admission model discriminated continued ICU-level care requirement or death at 48 hours with an AUC of 0.820 (95% CI 0.748–0.891).
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