Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia

Abstract

Background: Unplanned ICU admission after surgery has been validated as a measure of a quality indicator of perioperative management because it may put surgical patients at risk of increased morbidity and mortality. Postoperative unscheduled admission to the ICU is usually determined either in the post-anesthesia care unit (PACU) or in the general surgical ward; however, it could be expected patient outcomes after ICU admission would be affected by the circumstances. The purpose of this retrospective observational study was to investigate the clinical characteristics and the outcome of unplanned admission to the ICU directly from the PACU or from the ward within 7 days after PACU discharge.

Methods: Forty-three thousand, five hundred fifty-three patients admitted to the PACU after general anesthesia were included in the study. Unplanned ICU admission was defined as the admission which was not anticipated preoperatively but was due to adverse events in the PACU (PACU group) or the ward after discharge from the PACU (Ward group). The following parameters were compared between the groups: patient characteristics, surgical characteristics, length of ICU and hospital stay, the principal adverse event for ICU admission, treatments in the ICU, and in-hospital mortality. The primary outcome was in-hospital mortality and the second was the length of ICU and hospital stay.

Results: Among 43,553 patients, 109 patients underwent unplanned ICU admission directly from the PACU (n= 73, 0.17%) or subsequently from the ward (n= 36, 0.08%). The length of both ICU and hospital stay was significantly longer in the Ward group than in the PACU group (1.4 and 19 days vs. 2.5 and 39 days, respectively). There was no significant difference in in-hospital mortality between the groups (4.1% vs. 8.3%, respectively).

Conclusions: The incidence of unplanned ICU admission after PACU stay was low, however, delayed admission to the ICU from the ward may prolong the length of both ICU and hospital stay compared to those directly from the PACU.

Keywords: Intensive care unit; Non-cardiac surgery; Post-anesthesia care unit; Prolonged stay; Unplanned admission.

Fig. 1

Percentage of adverse events leading to unplanned ICU admission in each group. The most frequent adverse events leading to unplanned ICU admission were cardiovascular events followed by respiratory ones. Anesthetic events were specific to the PACU group