Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 26;25(1):268.
doi: 10.1186/s12871-025-03137-4.

Early deep sedation was associated with post-hospital one-year mortality in critically ill surgical patients: a propensity-matched retrospective cohort study

Peng-Yen Wu #  1   2 , Shang-Yi Lee #  3   4 , Li-Ting Wong  5 , Wen-Cheng Chao  6   7   8
Affiliations

Early deep sedation was associated with post-hospital one-year mortality in critically ill surgical patients: a propensity-matched retrospective cohort study

Peng-Yen Wu et al. BMC Anesthesiol. .

Abstract

Objective: Sedation is a crucial issue in critical care, but the impact of early deep sedation on post-hospital mortality in critically ill surgical patients remains unclear.

Methods: We linked the 2015-2020 critical care database at Taichung Veterans General Hospital with the nationwide death registration in Taiwan. Log-rank test was used to estimate survival curves between patients with and without deep sedation, defined by the average Richmond Agitation-Sedation Scale (RASS) level within the first 3 days equal to or lower than - 3. A multivariable Cox proportional hazards regression model was used to determine hazard ratios (HR) and 95% confidence intervals (CI). Furthermore, we used propensity score-matching (PSM) analysis to validate the association.

Results: A total of 7,135 critically ill surgical patients were enrolled, and 13.7% of them experienced early deep sedation. Independent predictors for post-hospital one-year mortality included old age, male, more comorbidities, high acute physiology and chronic health evaluation (APACHE) II score, and low body mass index. We noted that receiving midazolam (aHR 1.368, 95% CI 1.052-1.780) or propofol (aHR 1.459, 95% CI 1.136-1.874) was associated with increased mortality compared with dexmedetomidine. Early deep sedation was independently associated with post-hospital mortality after adjusting for covariates (aHR 1.216, 95% CI 1.019-1.452), and the association remained robust in the PSM analysis (aHR 1.313, 95% CI 1.054-1.636).

Conclusion: We identified the association between early deep sedation and post-hospital mortality, a modifiable factor, in critically ill surgical patients. Further prospective studies are warranted to confirm our findings.

Keywords: Critical illness; Deep sedation; Long-term outcome; Post-hospital mortality; Surgery.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of the Taichung Veterans General Hospital TCVGH: SE20249B#1). All the data were anonymised data, and informed consent was waived by the Institutional Review Board of Taichung Veterans General Hospital. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of subject enrollment. Abbreviations: ICU, intensive care unit; TCVGH, Taichung Veterans General Hospital
Fig. 2
Fig. 2
Kaplan-Meier survival curves for patients with and without early deep sedation
Fig. 3
Fig. 3
Flowchart of subject enrollment in the propensity score-matched patients
See this image and copyright information in PMC

References

    1. Devlin JW, Skrobik Y, Gelinas C, Needham DM, Slooter AJC, Pandharipande PP, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2018;46:e825–73. - PubMed
    1. Shehabi Y, Chan L, Kadiman S, Alias A, Ismail WN, Tan MA, et al. Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med. 2013;39:910–8. - PMC - PubMed
    1. Balzer F, Weiss B, Kumpf O, Treskatsch S, Spies C, Wernecke KD, et al. Early deep sedation is associated with decreased in-hospital and two-year follow-up survival. Crit Care. 2015;19:197. - PMC - PubMed
    1. Stephens RJ, Evans EM, Pajor MJ, Pappal RD, Egan HM, Wei M, et al. A dual-center cohort study on the association between early deep sedation and clinical outcomes in mechanically ventilated patients during the COVID-19 pandemic: the COVID-SED study. Crit Care. 2022;26:179. - PMC - PubMed
    1. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and new Zealand, 2000–2012. JAMA. 2014;311:1308–16. - PubMed

MeSH terms

LinkOut - more resources