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Exposure to surgery is associated with better long-term outcomes in patients admitted to Swedish intensive care units

Jawad, Monir LU orcid ; Baigi, Amir and Chew, Michelle LU (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.

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type
Contribution to journal
publication status
published
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in
Acta Anaesthesiologica Scandinavica
volume
64
issue
8
pages
8 pages
publisher
Wiley-Blackwell
external identifiers
  • pmid:32297658
  • scopus:85083985055
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
2024-01-02 11:46:03
@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 &lt;.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 &lt;.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}},
}