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Observational Study
. 2020 Mar;32(1):17-27.
doi: 10.5935/0103-507x.20200005. Epub 2020 May 8.

Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

[Article in English, Portuguese]
João Manoel Silva Júnior  1 , Renato Carneiro de Freitas Chaves  1 , Thiago Domingos Corrêa  1 , Murillo Santucci Cesar de Assunção  1 , Henrique Tadashi Katayama  2 , Fabio Eduardo Bosso  3 , Cristina Prata Amendola  4 , Ary Serpa Neto  1 , Luiz Marcelo Sá Malbouisson  5 , Neymar Elias de Oliveira  6 , Viviane Cordeiro Veiga  7 , Salomón Soriano Ordinola Rojas  7 , Natalia Fioravante Postalli  7 , Thais Kawagoe Alvarisa  7 , Bruno Melo Nobrega de Lucena  5 , Raphael Augusto Gomes de Oliveira  5 , Luciana Coelho Sanches  4 , Ulysses Vasconcellos de Andrade E Silva  4 , Antonio Paulo Nassar Junior  8
Affiliations
Observational Study

Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

[Article in English, Portuguese]
João Manoel Silva Júnior et al. Rev Bras Ter Intensiva. 2020 Mar.

Abstract
in English, Portuguese

Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil.

Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated.

Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051).

Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

Objetivo: Definir o perfil epidemiológico e os principais determinantes de morbimortalidade dos pacientes cirúrgicos não cardíacos de alto risco no Brasil.

Métodos: Estudo prospectivo, observacional e multicêntrico. Todos os pacientes cirúrgicos não cardíacos admitidos nas unidades de terapia intensiva, ou seja, considerados de alto risco, no período de 1 mês, foram avaliados e acompanhados diariamente por, no máximo, 7 dias na unidade de terapia intensiva, para determinação de complicações. As taxas de mortalidade em 28 dias de pós-operatório, na unidade de terapia intensiva e hospitalar foram avaliadas.

Resultados: Participaram 29 unidades de terapia intensiva onde foram realizadas cirurgias em 25.500 pacientes, dos quais 904 (3,5%) de alto risco (intervalo de confiança de 95% - IC95% 3,3% - 3,8%), tendo sido incluídos no estudo. Dos pacientes envolvidos, 48,3% eram de unidades de terapia intensiva privadas e 51,7% de públicas. O tempo de internação na unidade de terapia intensiva foi de 2,0 (1,0 - 4,0) dias e hospitalar de 9,5 (5,4 - 18,6) dias. As taxas de complicações foram 29,9% (IC95% 26,4 - 33,7) e mortalidade em 28 dias pós-cirurgia 9,6% (IC95% 7,4 - 12,1). Os fatores independentes de risco para complicações foram Simplified Acute Physiology Score 3 (SAPS 3; razão de chance − RC = 1,02; IC95% 1,01 - 1,03) e Sequential Organ Failure Assessment Score (SOFA) da admissão na unidade de terapia intensiva (RC =1,17; IC95% 1,09 - 1,25), tempo de cirurgia (RC = 1,001; IC95% 1,000 - 1,002) e cirurgias de emergências (RC = 1,93; IC95% 1,10 - 3,38). Em adição, foram associados com mortalidade em 28 dias idade (RC = 1,032; IC95% 1,011 - 1,052) SAPS 3 (RC = 1,041; IC95% 1,107 - 1,279), SOFA (RC = 1,175; IC95% 1,069 - 1,292) e cirurgias emergenciais (RC = 2,509; IC95% 1,040 - 6,051).

Conclusão: Pacientes com escores prognósticos mais elevados, idosos, tempo cirúrgico e cirurgias emergenciais estiveram fortemente associados a maior mortalidade em 28 dias e mais complicações durante permanência em unidade de terapia intensiva.

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Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Flowchart of the study participants. ICU - intensive care unit.
Figure 2
Figure 2
Occurrence of and confidence intervals for mortality (A) and postoperative complications (B). ICU - intensive care unit.
Figure 3
Figure 3
Risk factors related to intensive care unit and hospital mortality (multivariate analysis). ICU - intensive care unit; SAPS 3 - Simplified Acute Physiology Score 3; SOFA - Sequential Organ Failure Assessment Score; ASA - American Society of Anesthesiologists.
See this image and copyright information in PMC

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