Pre-operative evaluation using therapeutic intensity scoring

Abstract

Background and objective: A Pre-operative Therapeutic Intensity Score (P-TIS) was developed to quantify intensity of pre-operative care. Its association with post-operative ICU admission was explored.

Methods: P-TIS assigns 1-4 points to therapeutic interventions and diagnostic procedures based on care intensity. P-TIS was evaluated using elective (n = 716) and emergency (n = 289) surgery patients entering the post-anaesthesia care unit (PACU) or directly admitted to ICU.

Results: P-TIS has chronic (interventions >48 h before surgery, e.g. chronic dialysis therapy: 3 points, oral antibiotics: 1 point) and acute (interventions within 48 h of surgery, e.g. intra-aortic balloon: 4 points, urinary catheter insertion: 1 point) components. Acute P-TIS provided quantitative information, not provided by other methods, about care intensity immediately before surgery. High acute P-TIS were observed in elective patients with high chronic P-TIS and ASA classifications (3 and 4) and emergency surgery and trauma. The higher acute P-TIS, the more likely emergency patients are to receive post-operative ICU rather than intermediate or routine floor care (odds ratio 1.18, P < 0.001). Adding surgical complexity improved acute P-TIS's ability to predict post-operative ICU care in elective patients.

Conclusion: P-TIS quantifies the intensity of chronic and acute pre-operative care. Acute P-TIS predicted receipt of post-operative ICU care, especially in emergency surgery.