Exposure to surgery is associated with better long-term outcomes in patients admitted to Swedish intensive care units
(2020) In Acta Anaesthesiologica Scandinavica 64(8). p.1154-1161- Abstract
Background: Long-term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long-term effects of surgical exposure prior to ICU admission. Methods: Registry-based cohort study. The adjusted effect of surgical exposure for mortality was examined using Cox regression. Secondary analysis with conditional logistic regression in a case-control subpopulation matched for age, gender, and Simplified Acute Physiology Score III (SAPS3) was also conducted. Results: 72 242 adult patients (56.9% males, median age 66 years [IQR 50-76]), admitted to Swedish ICUs in 3-year (2012-2014) were followed for a median of 2026 days (IQR 1745-2293). Cardiovascular diseases (17.5%), respiratory diseases... (More)
Background: Long-term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long-term effects of surgical exposure prior to ICU admission. Methods: Registry-based cohort study. The adjusted effect of surgical exposure for mortality was examined using Cox regression. Secondary analysis with conditional logistic regression in a case-control subpopulation matched for age, gender, and Simplified Acute Physiology Score III (SAPS3) was also conducted. Results: 72 242 adult patients (56.9% males, median age 66 years [IQR 50-76]), admitted to Swedish ICUs in 3-year (2012-2014) were followed for a median of 2026 days (IQR 1745-2293). Cardiovascular diseases (17.5%), respiratory diseases (15.8%), trauma (11.2%), and infections (11.4%) were the leading causes for ICU admission. Mortality at longest follow-up was 49.4%. Age; SAPS3; admissions due to malignancies, respiratory, cardiovascular and renal diseases; and transfer to another ICU were associated with increased mortality. Surgical exposure prior to ICU admission (adjusted hazard ratio [aHR] 0.90; 95% CI 0.87-0.94; P <.001), admissions from the operation theatre (aHR 0.94; CI 0.90-0.99; P =.022) or post-anaesthesia care unit (aHR 0.92; CI 0.87-0.97; P =.003) were associated with decreased mortality. Conditional logistic regression confirmed the association between surgical exposure and decreased mortality (adjusted odds ratio 0.82; CI 0.75-0.91; P <.001). Conclusions: Long-term ICU mortality was associated with known risk factors such as age and SAPS3. Transfer to other ICUs also appeared to be a risk factor and requires further investigation. Prior surgical exposure was associated with better outcomes, a noteworthy observation given limited ICU admissions after surgery in Sweden.
(Less)
- author
- Jawad, Monir LU ; Baigi, Amir and Chew, Michelle LU
- organization
- publishing date
- 2020-09
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 64
- issue
- 8
- pages
- 8 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85083985055
- pmid:32297658
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.13604
- language
- English
- LU publication?
- yes
- id
- be57b47f-441d-4468-841f-0b2ea16444e6
- date added to LUP
- 2020-05-28 13:49:15
- date last changed
- 2024-04-03 08:42:24
@article{be57b47f-441d-4468-841f-0b2ea16444e6, abstract = {{<p>Background: Long-term outcomes of patients admitted to intensive care units (ICUs) after surgery are unknown. We investigated the long-term effects of surgical exposure prior to ICU admission. Methods: Registry-based cohort study. The adjusted effect of surgical exposure for mortality was examined using Cox regression. Secondary analysis with conditional logistic regression in a case-control subpopulation matched for age, gender, and Simplified Acute Physiology Score III (SAPS3) was also conducted. Results: 72 242 adult patients (56.9% males, median age 66 years [IQR 50-76]), admitted to Swedish ICUs in 3-year (2012-2014) were followed for a median of 2026 days (IQR 1745-2293). Cardiovascular diseases (17.5%), respiratory diseases (15.8%), trauma (11.2%), and infections (11.4%) were the leading causes for ICU admission. Mortality at longest follow-up was 49.4%. Age; SAPS3; admissions due to malignancies, respiratory, cardiovascular and renal diseases; and transfer to another ICU were associated with increased mortality. Surgical exposure prior to ICU admission (adjusted hazard ratio [aHR] 0.90; 95% CI 0.87-0.94; P <.001), admissions from the operation theatre (aHR 0.94; CI 0.90-0.99; P =.022) or post-anaesthesia care unit (aHR 0.92; CI 0.87-0.97; P =.003) were associated with decreased mortality. Conditional logistic regression confirmed the association between surgical exposure and decreased mortality (adjusted odds ratio 0.82; CI 0.75-0.91; P <.001). Conclusions: Long-term ICU mortality was associated with known risk factors such as age and SAPS3. Transfer to other ICUs also appeared to be a risk factor and requires further investigation. Prior surgical exposure was associated with better outcomes, a noteworthy observation given limited ICU admissions after surgery in Sweden.</p>}}, author = {{Jawad, Monir and Baigi, Amir and Chew, Michelle}}, issn = {{0001-5172}}, language = {{eng}}, number = {{8}}, pages = {{1154--1161}}, publisher = {{Wiley-Blackwell}}, series = {{Acta Anaesthesiologica Scandinavica}}, title = {{Exposure to surgery is associated with better long-term outcomes in patients admitted to Swedish intensive care units}}, url = {{http://dx.doi.org/10.1111/aas.13604}}, doi = {{10.1111/aas.13604}}, volume = {{64}}, year = {{2020}}, }