Clinical Outcome and Prognosis of Patients Admitted to the Surgical ICU after Abdomen Surgery
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Background: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications,unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. Methods: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. Results: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion[p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortalityin univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. Conclusions: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered importantpredictors of mortality.
Abstract
Background: Postoperative admission to the surgical intensive care unit (S-ICU) is commonly planned to prevent and treat complications,unnecessary admission to the S-ICU increases medical costs and length of hospital stay. This study aimed evaluated outcome and the predictive factors for mortality in patients admitted to the S-ICU after abdominal surgery. Methods: The 168 patients admitted to the S-ICU immediately after abdominal surgery were reviewed retrospectively from January to December 2011. Results: The mortality rate of patients admitted to the S-ICU after abdominal surgery was 8.9% (15 of 168). Two preoperative factors (body mass index [BMI] < 18.5 kg/m2 [p < 0.001] and serum albumin < 3.0 g/dL [p = 0.018]), two operative factors (the need for transfusion[p = 0.008] or vasopressors [p = 0.013] during surgery), and three postoperative variables (mechanical ventilation immediately following surgery [p < 0.001], sequential organ failure assessment [p = 0.001] and SAPS II [p = 0.001] score) were associated with mortalityin univariate analysis. After adjusting for age, gender, and SAPS II by a Cox regression, which revealed that BMI < 18.5 kg/m2 (p < 0.001, hazard ratio [HR] 9.690, 95% confidence interval [CI] 2.990-25.258) and the use of mechanical ventilation on admission to S-ICU (p < 0.001, HR 34.671, 95% CI 6.440-186.649) were independent prognostic factors. Conclusions: In patients in S-ICU after abdominal surgery, low BMI and postsurgical mechanical ventilation should be considered importantpredictors of mortality.
참고문헌 (28)
- Sirio CA, "Who goes to the ICU postoperatively?", Chest, 115, pp.125S~129S (1999)
- Bastounis E, "Selective use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair", Int Angiol, 22, pp.308~316 (2003)
- Bertges DJ, "Is routine use of the intensive care unit after elective infrarenal abdominal aortic aneurysm repair necessary?", J Vasc Surg, 32, pp.634~642 (2000)
- To EW, "Retrospective study on the need of intensive care unit admission after major head and neck surgery", ANZ J Surg, 72, pp.11~14 (2002)
- Atalay F, "Postoperative complications after abdominal surgery in patients with chronic obstructive pulmonary disease", Turk J Gastroenterol, 22, pp.523~528 (2011)
- Bapoje SR, "Preoperative evaluation of the patient with pulmonary disease", Chest, 132, pp.1637~1645 (2007)
- Kroenke K, "Postoperative complications after thoracic and major abdominal surgery in patients with and without obstructive lung disease", Chest, 104, pp.1445~1451 (1993)
- Massarweh NN, "Impact of advancing age on abdominal surgical outcomes", Arch Surg, 144, pp.1108~1114 (2009)
- Mullen JT, "Impact of body mass index on perioperative outcomes in patients undergoing major intra-abdominal cancer surgery", Ann Surg Oncol, 15, pp.2164~2172 (2008)
- WHO Expert Consultation, "Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies", Lancet, 363, pp.157~163 (2004)
- Azoulay E, "Determinants of postintensive care unit mortality: a prospective multicenter study", Crit Care Med, 31, pp.428~432 (2003)
- Rhodes A, "Epidemiology and outcome following post-surgical admission to critical care", Intensive Care Med, 37, pp.1466~1472 (2011)
- Cavaliere F, "Intensive care after elective surgery: a survey on 30-day postoperative mortality and morbidity", Minerva Anestesiol, 74, pp.459~468 (2008)
- Haidri FR, "Role of APACHE score in predicting mortality in chest ICU", J Pak Med Assoc, 61, pp.589~592 (2011)
- Eng PC, "Mortality patterns in a medical intensive care unit", Singapore Med J, 33, pp.24~26 (1992)
- Fasol R, "The influence of obesity on perioperative morbidity: retrospective study of 502 aortocoronary bypass operations", Thorac Cardiovasc Surg, 40, pp.126~129 (1992)
- Lee CT, "Impact of body mass index on radical cystectomy", J Urol, 172, pp.1281~1285 (2004)
- Prem KA, "Operative treatment of adenocarcinoma of the endometrium in obese women", Am J Obstet Gynecol, 92, pp.16~21 (1965)
- Dindo D, "Obesity in general elective surgery", Lancet, 361, pp.2032~2035 (2003)
- Klasen J, "The effect of intravenous lidocaine on somatosensory evoked potentials during scoliosis surgery", Anesth Analg, 85, pp.228~ (1997)
- Thomas EJ, "Body mass index as a correlate of postoperative complications and resource utilization", Am J Med, 102, pp.277~283 (1997)
- Pai MP, "Antimicrobial dosing considerations in obese adult patients", Pharmacotherapy, 27, pp.1081~1091 (2007)
- Jee SH, "Body-mass index and mortality in Korean men and women", N Engl J Med, 355, pp.779~787 (2006)
- Zheng W, "Association between body-mass index and risk of death in more than 1 million Asians", N Engl J Med, 364, pp.719~729 (2011)
- Lim SY, "Body mass index and mortality in Korean intensive care units: a prospective multicenter cohort study", PLoS One, 9, pp.e90039~ (2014)
- 임소연, "The Body Mass Index as a Prognostic Factor of Critical Care", The Korean Journal of Internal Medicine, 25(2), pp.162~167 (2010), 대한내과학회
- Peake SL, "The effect of obesity on 12-month survival following admission to intensive care: a prospective study", Crit Care Med, 34, pp.2929~2939 (2006)
- Chiumello D, "Non-invasive ventilation in postoperative patients: a systematic review", Intensive Care Med, 37, pp.918~929 (2011)