08 / Perioperative risk factors for determining the unplanned admission to an Intensive Care Unit after surgery

Abstract Background Postoperative pulmonary complications (PPCs) contribute significantly to overall postoperative morbidity and mortality. In abdominal surgery, PPCs remain frequent. The study aimed to analyze the profile and outcomes of PPCs in patients submitted to abdominal surgery and admitted in a Portuguese polyvalent intensive care unit. Methods From January to December 2017 in the polyvalent intensive care unit of Hospital Garcia de Orta, Almada, Portugal, we conducted a retrospective, observational study of inpatients submitted to urgent or elective abdominal surgery who had severe PPCs. We evaluated the perioperative risk factors and associated mortality. Logistic regression was performed to find which perioperative risk factors were most important in the occurrence of PPCs. Results Sixty patients (75% male) with a median age of 64.5 [47–81] years who were submitted to urgent or elective abdominal surgery were included in the analysis. Thirty-six patients (60%) developed PPCs within 48 h and twenty-four developed PPCs after 48 h. Pneumonia was the most frequent PPC in this sample. In this cohort, 48 patients developed acute respiratory failure and needed mechanical ventilation. In the emergency setting, peritonitis had the highest rate of PPCs. Electively operated patients who developed PPCs were mostly carriers of digestive malignancies. Thirty-day mortality was 21.7%. The risk of PPCs development in the first 48 h was related to the need for neuromuscular blocking drugs several times during surgery and preoperative abnormal arterial blood gases. Median abdominal surgical incision, long surgery duration, and high body mass index were associated with PPCs that occurred more than 48 h after surgery. The American Society of Anesthesiologists physical status score 4 and COPD/Asthma determined less mechanical ventilation needs since they were preoperatively optimized. Malnutrition (low albumin) before surgery was associated with 30-day mortality. Conclusion PPCs after abdominal surgery are still a major problem since they have profound effects on outcomes. Our results suggest that programs before surgery, involve preoperative lifestyle changes, such as nutritional supplementation, exercise, stress reduction, and smoking cessation, were an effective strategy in mitigating postoperative complications by decreasing mortality.

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Perioperative risk factors for early intensive care delirium following cardiac surgery

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2016.03.160 ◽

2016 ◽

Vol 30 ◽

pp. S35

Author(s):

Vilma Kuzminskaite ◽

I Norkiene ◽

M Kaukenaite ◽

A Komarovec

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Intensive Care ◽

Perioperative Risk ◽

Perioperative Risk Factors

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Risk Factors and Reasons for Treatment Abandonment for Patients With Esophageal Atresia: A Study From a Tertiary Care Hospital in Beijing, China

Frontiers in Pediatrics ◽

10.3389/fped.2021.634573 ◽

2021 ◽

Vol 9 ◽

Author(s):

Shen Yang ◽

Junmin Liao ◽

Siqi Li ◽

Kaiyun Hua ◽

Peize Wang ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Surgical Repair ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Unplanned Admission ◽

Independent Risk Factors ◽

Treatment Abandonment

Background: This study aims to identify the risk factors and reasons for treatment abandonment for patients with esophageal atresia (EA) in a tertiary care hospital in China.Methods: A retrospective study was conducted on 360 patients with EA admitted to Beijing Children's Hospital between January 1, 2007 and June 1, 2020. Medical records for treatment abandonment and non-treatment abandonment patients were compared. Univariate and multivariate logistic regression analyses were conducted to identify potential risk factors for treatment abandonment.Results: After the diagnosis of EA, parents of 107 patients refused surgical repair and discharged against medical advice, and 253 patients underwent surgical repair. Among these 253 patients, parents of 59 patients abandoned treatment after surgery; 52 patients were discharged in an unstable condition, and parents of seven patients abandoned resuscitation leading to death in the hospital. By comparing clinical characteristics between treatment abandonment before surgery (n = 107) and non-treatment abandonment (n = 253) groups, we found that mother's parity >1, unplanned admission to intensive care unit before surgery, associated anomalies, and Gross type A/B were significant independent risk factors for treatment abandonment before surgery. Furthermore, birth weight <2,545 g, being discharged from neonatal center/intensive care unit and other departments, unplanned admission to intensive care unit after surgery, operative time >133 min, admission before 2016, pneumothorax, and anastomotic leakage were significant independent risk factors for treatment abandonment after surgery. The reasons for treatment abandonment included financial difficulties, multiple malformations with poor prognosis, belief of incurability and concerns about the prognosis of the diseases, postoperative complications, and extensive length of intensive care unit stay.Conclusions: Treatment abandonment of children with EA/TEF is still a common and serious problem in China. This study showed that EA/TEF patients in critical conditions, with associated anomalies, Gross type A/B, and who had occurrence of complications had high-risk for treatment abandonment.

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Letter to the Editor on “Risk Factors for Unplanned Admission to the Intensive Care Unit After Elective Total Joint Arthroplasty”

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.05.004 ◽

2020 ◽

Vol 35 (10) ◽

pp. 3058-3059

Author(s):

Atul F. Kamath ◽

Nicolas S. Piuzzi

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Unplanned Admission ◽

Letter To The Editor

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Risk Factors for Unplanned Admission to the Intensive Care Unit After Elective Total Joint Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.03.003 ◽

2020 ◽

Vol 35 (7) ◽

pp. 1937-1940 ◽

Cited By ~ 2

Author(s):

Kamolsak Sukhonthamarn ◽

Matthew J. Grosso ◽

Matthew B. Sherman ◽

Camilo Restrepo ◽

Javad Parvizi

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Total Joint Arthroplasty ◽

Joint Arthroplasty ◽

Unplanned Admission

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Risk Factors for Unplanned Admission to the Pediatric Intensive Care Unit in Pediatric Trauma Patients

Proceedings of IMPRS ◽

10.18060/23579 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

William Schrock ◽

Jodi Raymond, MPH ◽

Matthew Landman, MD, MPH

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Logistic Regression ◽

Intensive Care ◽

Traumatic Injury ◽

Pediatric Trauma ◽

Significant Risk ◽

Pediatric Intensive Care ◽

Multiple Logistic Regression ◽

Unplanned Admission

Background and Hypothesis: A number of risk factors for unplanned pediatric intensive care unit (PICU) admission and readmission have been identified. However, little is known of the risk factors associated with unplanned admission to the PICU in pediatric trauma populations. We hypothesize specific risk factors can be identified which may be associated with unplanned admission to the PICU following traumatic injury. Methods: For this national retrospective study, we queried the 2016 National Trauma Data Bank for patients younger than 18 years experiencing a traumatic injury requiring hospital admission from the Emergency Department (ED). We excluded patients who had experienced burn injuries. Statistically significant (p<.05) risk factors for unplanned PICU admission were identified in bivariate analysis and used to build a multiple logistic regression model. Results: Patients experiencing unplanned admission to the PICU had lower ED Glasgow Coma Scale (11.83 vs. 14.31; p<0.001), higher Injury Severity Scores (ISS) (17.96 vs. 7.32; p<0.001), and were older (age 11.35 vs. 9.60; p<0.001). Initial ED disposition to the PICU was significantly associated with unplanned admission to the PICU (p<0.001). Initial ED disposition to the OR was significantly associated with unplanned admission to the PICU (p=.018). After multiple logistic regression, ISS (p<0.001), initial ED disposition to the PICU (p=0.002), initial ED disposition to the OR (p=0.005), and older age (p=0.005) remained statistically significant risk factors for unplanned admission to the PICU. Conclusion: ISS and ED disposition to the PICU, OR disposition to the PICU and age are significant risk factors for unplanned admission to the PICU in pediatric trauma. These findings will assist in identifying patients at risk for unplanned admission to the PICU, thereby reducing the adverse effects of unplanned PICU admission and ultimately improving the quality of care for pediatric trauma populations.

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