Incidence and factors associated with postoperative intensive care unit admission in Thungsong Hospital, Nakhon Si Thammarat Province
Keywords:
Postoperative care, Associated factors, High-risk patient, Complications, Intensive care unitAbstract
Background: High-risk surgical patients were recommended to admitted to the intensive care unit (ICU) in order to reduce postoperative complications and mortality. However, ICU resources are limited. Identifying factors thus is crucial to operate the ICU admissions efficiently.
Objectives: To identify the incidence and factors associated with the postoperative ICU admissions.
Methods: A retrospective, case-control study was conducted in patients who underwent the surgeries in Thungsong hospital between October 1st, 2018 to September 30th, 2023. The associations between the surgical patients with the potential factors were analyzed using univariate and multiple logistic regressions.
Results: 695 out of 30,671 patients (2.3%) underwent the postoperative ICU admissions. The results showed that ASA class III, coronary artery disease, heart failure, general anesthesia, operative time ≥ 180 minute, blood loss 750-1,500 ml, blood loss > 1,500 ml, hypotension, hypoxemia, bronchospasm, difficult intubation and MEWS after surgery ≥ 4 significantly contributed to the postoperative ICU admissions. Also, the inotrope or vasopressor infusion, MEWS at ICU 6-7 and MEWS at ICU ≥ 8 were significant factors associated with the ICU mortality.
Conclusion: The findings highlighted the important factors related to the postoperative ICU admissions. The patients with these factors require the attentive care from health professions to reduce the risk of morbidity and mortality.
References
Laor A, Tal S, Guller V, Zbar AP, Mavor E. The Charlson Comorbidity Index (CCI) as a Mortality Predictor after Surgery in Elderly Patients. Am Surg. 2016;82(1):22-7.
Ghaffar S, Pearse RM, Gillies MA. ICU admission after surgery: who benefits? Curr Opin Crit Care. 2017;23(5):424-9.
Lan L, Chen F, Luo J, Li M, Hao X, Hu Y, et al. Prediction of intensive care unit admission (>24h) after surgery in elective noncardiac surgical patients using machine learning algorithms. Digit Health. 2022;8:20552076221110543.
Uzman S, Yilmaz Y, Toptas M, Akkoc I, Gul YG, Daskaya H, et al. A retrospective analysis of postoperative patients admitted to the intensive care unit. Hippokratia. 2016;20(1):38-43.
Patel SK, Kacheriwala SM, Duttaroy DD. Audit of Postoperative Surgical Intensive Care Unit Admissions. Indian J Crit Care Med. 2018;22(1):10-5.
Kay HF, Chotai S, Wick JB, Stonko DP, McGirt MJ, Devin CJ. Preoperative and surgical factors associated with postoperative intensive care unit admission following operative treatment for degenerative lumbar spine disease. Eur Spine J. 2016;25(3):843-9.
Abrol N, Kashyap R, Frank RD, Iyer VN, Dean PG, Stegall MD, et al. Preoperative Factors Predicting Admission to the Intensive Care Unit After Kidney Transplantation. Mayo Clin Proc Innov Qual Outcomes. 2019;3(3):285-93.
Sobol JB, Wunsch H. Triage of high-risk surgical patients for intensive care. Crit Care. 2011;15(2):217.
Onwochei DN, Fabes J, Walker D, Kumar G, Moonesinghe SR. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia. 2020;75 Suppl 1:e62-e74.
AbdelSalam H, Restrepo C, Tarity TD, Sangster W, Parvizi J. Predictors of intensive care unit admission after total joint arthroplasty. J Arthroplasty. 2012;27(5):720-5.
Wanderer JP, Anderson-Dam J, Levine W, Bittner EA. Development and validation of an intraoperative predictive model for unplanned postoperative intensive care. Anesthesiology. 2013;119(3):516-24.
Park JH, Kim DH, Kim BR, Kim YW. The American Society of Anesthesiologists score influences on postoperative complications and total hospital charges after laparoscopic colorectal cancer surgery. Medicine (Baltimore). 2018;97(18):e0653.
Ionescu D. Pro: All High-Risk Cardiac Patients Need to Be Admitted to the Intensive Care Unit After Major Noncardiac Surgery. J Cardiothorac Vasc Anesth. 2025.
Bruceta M, De Souza L, Carr ZJ, Bonavia A, Kunselman AR, Karamchandani K. Post-operative intensive care unit admission after elective non-cardiac surgery: A single-center analysis of the NSQIP database. Acta Anaesthesiol Scand. 2020;64(3):319-28.
Helander EM, Webb MP, Menard B, Prabhakar A, Helmstetter J, Cornett EM, et al. Metabolic and the Surgical Stress Response Considerations to Improve Postoperative Recovery. Curr Pain Headache Rep. 2019;23(5):33.
Phoowanakulchai S, Jirauraipong Y, Kongsayreepong S, Therasakvichya S, Nivatpumin P, Somnuke P. Rate and Factors Related to Postoperative Intensive Care Unit (ICU) Utilization in Elective Gynecologic Oncology Patients. 2022;48:99-112.
Sawhney C, Kaur M, Gupta B, Singh PM, Gupta A, Kumar S, et al. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center. Saudi J Anaesth. 2014;8(Suppl 1):S29-35.
Raju S, Gulati V, Nidadavolu V, Ingrassia J, Cox J, Kumar A, et al. 698: Modified Early Warning Score (MEWS) as a prediction tool for Intensive Care Unit (ICU) admissions. Critical Care Medicine. 2013;41(12):A172.
Gardner-Thorpe J, Love N, Wrightson J, Walsh S, Keeling N. The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Ann R Coll Surg Engl. 2006;88(6):571-5.
Gao F, Zhang Y. Inotrope Use and Intensive Care Unit Mortality in Patients With Cardiogenic Shock: An Analysis of a Large Electronic Intensive Care Unit Database. Front Cardiovasc Med. 2021;8:696138.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Region11Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
