Admission to surgical intensive care unit in time with intensivist coverage and its association with postoperative 30-day mortality: The role of intensivists in a surgical intensive care unit

Abstract

Background: This study aimed to investigate the association between postoperative surgical Intensive Care Unit (ICU) admission during a time when there was intensivist coverage and 30-day mortality after ICU admission.

Methods: This was a retrospective observational study in a tertiary care academic hospital ICU, with daytime intensivist coverage. We collected the electronic medical records for all patients who were admitted to the postoperative ICU after undergoing a surgery between January 1, 2007 and December 31, 2016. The primary outcome was to examine the differences in 30-day mortality after ICU admission according to ICU admission during times of intensivist or non-intensivist coverage.

Results: Overall, 13,906 patients were included (6634 [47.7%] patients were admitted with intensivist coverage, and 7272 [52.3%] patients without intensivist coverage). After performing propensity Score matching, 10,708 patients (5354 patients in each group) were analysed. In the matched cohorts, 30-day mortality after postoperative ICU admission in the group without intensivist coverage was higher than that with intensivist coverage [30-day mortality, 251/5354 (4.7%) and 173/5354 (3.2%) in the groups without and with intensivist coverage, respectively, P < 0.001]. Post-operative ICU admission in the group without intensivist coverage was associated with an increased risk of 30-day mortality (risk ratio: 1.45, 95% confidence interval: 1.20-1.75, P < 0.001).

Conclusion: This study showed an increase in post-operative 30-day mortality, and length of hospital and ICU stay for surgical ICU admission among those without intensivist coverage.

Keywords: Intensive care units; Mortality; Time.