Factors Predicting Urgent-Surgery Trauma Patients’ Postoperative Admission to ICU
Keywords:surgical site, preoperative consciousness level, preoperative shock, perioperative estimated blood loss, postoperative ICU admission, trauma patients, urgent surgery
Objective: To study the predictive power of the surgical site, preoperative consciousness level, preoperative shock, perioperative estimated blood loss, and length of operation on urgentsurgery trauma patients’ need for post-operative admission to the ICU
Design: Retrospective predictive correlation design
Methodology: This study was conducted on a sample of 427 trauma patients aged 18 and above at a super-tertiary hospital in Bangkok. The patients were treated in the Emergency and Trauma Department before being transferred to the Urgent Surgery Ward. Data were collected between 1 January 2017 and 31 December 2019, using forms to record the demographic and clinical data, surgical site, consciousness level, shock index, perioperative estimated blood loss, length of operation, and details of postoperative ICU admission. Chi-square and binary logistic regression were employed for statistical analyses, with the level of signifcance set at .05.
Results: Male trauma patients formed the majority of the sample (80.56%). Of these, about half (42.15%) needed postoperative ICU admission. The factors identifed as being capable of signifcantly predicting the need for ICU admission included the surgical site, preoperative consciousness level, preoperative shock, and perioperative estimated blood loss, with a combined predictive power of 68% (Nagelkerke R2 = .68, p < .05).
Recommendations: It is recommended that nurses and multidisciplinary healthcare teams apply the factors of surgical site, preoperative consciousness level, preoperative shock, and perioperative estimated blood loss to determining the need for ICU treatment, to make most effective use of the ICU availability.
Di Saverio S, Gambale G, Coccolini F, Catena F, Giorgini E, Ansaloni L, et al. Changes in the outcomes of severe trauma patients from 15-year experience in a Western European trauma ICU of Emilia Romagna region (1996-2010). A population cross-sectional survey study. Langenbecks Arch Surg. 2014;399(1): 109-26.
Wang CH, Hsiao KY, Shih HM, Tsai YH, Chen IC. The role of trauma team activation by emergency physicians on outcomes in severe trauma patients. J Acute Med.2014;4(1):1-5. doi: 10.1016/j.jacme.2013.10.006.
McIsaac DI, Abdulla K, Yang H, Sundaresan S, Doering P, Vaswani SG, et al. Association of delay of urgent or emergency surgery with mortality and use of health care resources: a propensity score-matched observational cohort study. Can Med Assoc J.2017;189(27):E905-E12. doi: 10.1503/cmj.160576.
Havens JM, Peetz AB, Do WS, Cooper Z, Kelly E, Askari R, et al. The excess morbidity and mortality of emergency general surgery. J Trauma Acute Care Surg. 2015;78(2):306-11.
Ghaffar S, Pearse RM, Gillies MA. ICU admission after surgery: who benefts? Curr Opin Crit Care.2017;23(5):424-9. doi:10.1097/MCC.0000000000000448.
Helander EM, Webb MP, Menard B, Prabhakar A, Helmstetter J, Cornett EM, et al. Metabolic and the surgical stress response onsiderations to improve postoperative recovery. Curr Pain Headache Rep. 2019;23(5):33.
Matos AA, Silva DB, Jesus MLD, Guimaraes AR, Cordeiro ALL. Incidence of complications after cardiac surgery. Int Phys Med Rehab. 2020;5(1):25-8.
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-S35.doi: 10.4103/1658-354X.144065.
Alqaraf A, Alhazmi A, Alawf A, Alruhaili E, Alebrahaimi F, Sebeih S. The patterns of abdominal trauma and factors associated with ICU admission in a major trauma center in Medina. Australas Medical J. 2019;12(3):71-80. doi: 10.21767/AMJ.2018.3554.
Owojuyigbe A, Komolafe E, Dada O, Dada O, Adenekan A, Faponle A, et al. Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria. East Cent Afr J Surg. 2018;22:9.
Bagheri Sr, Alimohammadi E, Saeedi H, Sepehri P, Soleimani P, Fatahian R, et al. Decompressive craniectomy in traumatic brain injury: factors inﬂuencing prognosis and outcome. Iran J Neurosurg. 2017;3(1):21-6.
March K. Head injury and dysfunction. In: Good VS, Kirkwood PL, editors. Advanced critical care nursing. 2nd ed. St. Louis, Missouri: Elsevier; 2018.
Aisiku I, Robertson CS. Epidemiology and pathophysiology of traumatic brain injury. In: ebb A, Gattinoni L, editors. Oxford Textbook of critical care. 2nd ed. United Kingdom: Oxford University Press; 2016.
Michetti CP, Fakhry SM, Brasel K, Martin ND, Teicher EJ, Newcomb A. Trauma ICU prevalence project: the diversity of surgical critical care. Trauma Surg Acute Care Open. 2019;4(1):e000288. doi: 10.1136/tsaco-2018-000288.
Kim MJ, Park JY, Kim MK, Lee JG. Usefulness of Shock Index to predict outcomes of trauma patient: a retrospective cohort study. J Trauma Inj. 2019;32(1): 17-25. doi: 10.20408/jti.2018.034.
Brashers VL. Alterations of cardiovascular funcion. In: Huether SE, McCance KL, editors. Understanding pathophysiology. 6th ed. St. Louis, Missouri: Elsevier;2017. p. 598-686.
Sykes M. Using Shock Index as a predictor of ICU readmission: a quality improvement project [dissertation]. Master’s Theses and Capstones: University of New Hampshire; 2015.
Scott MJ, Miller TE. Pathophysiology of major surgery and the role of enhanced recovery pathways and the anesthesiologist to improve outcomes. Anesthesiol Clin. 2015;33(1):79-91. doi: 10.1016/j.anclin. 2014. 11.006.
Rolston JD, Han SJ, Lau CY, Berger MS, Parsa AT. Frequency and predictors of complications in neurological surgery: national trends from 2006 to 2011. J Neurosurg.2014;120(3):736-45. doi: 10.3171/2013.10.JNS122419.
Garraud O, Cognasse F, Laradi S, Hamzeh-Cognasse H, Peyrard T, Tissot JD, et al. How to mitigate the risk of inducing transfusion-associated adverse reactions. Transfus Clin Biol. 2018;25(4):262-8. doi: 10.1016/j.tracli.2018.07.006.
Havens JM, Do WS, Kaafarani H, Mesar T, Reznor G, Cooper Z, et al. Explaining the excess morbidity of emergency general surgery: packed red blood cell and fresh frozen plasma transfusion practices are associated with major complications in nonmassively transfused patients. Am J Surg. 2016;211(4):656-63.e4.
Rambachan A, Mioton LM, Saha S, Fine N, Kim JYS. The impact of surgical duration on plastic surgery outcomes. Eur J Plast Surg. 2013;36(11):707-14.doi: 10.1007/s00238-013-0851-2.
Hardy KL, Davis KE, Constantine RS, Chen M, Hein R, Jewell JL, et al. The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases. Aesthet Surg J. 2014;34(4):614-22. doi: 10.1177/1090820X14528503.
Motayagheni N, Phan S, Eshraghi C, Nozari A, Atala A. A review of anesthetic effects on renal function: potential organ protection. Am J Nephrol. 2017;46(5):380-9.doi: 10.1159/000482014.
Lees MC, Merani S, Tauh K, Khadaroo RG. Perioperative factors predicting poor outcome in elderly patients following emergency general surgery: a multivariate regression analysis. Can J Surg. 2015;58(5):312-17.doi: 10.1503/cjs.011614.
Ball R. Trauma. In: Good VS, Kirkwood PL, editors. Advanced critical care nursing. 2nd ed. St. Louis,Missouri: Elsevier; 2018.
Rajagopalan V, Chouhan RS, Pandia MP, Lamsal R, Rath GP. Effect of intraoperative blood loss on perioperative complications and neurological outcome in adult patients undergoing elective brain tumor surgery. J Neurosci Rural Pract. 2019;10(4):631-40.doi: 10.1055/s-0039-3399487.
Chalya PL, Gilyoma JM, Dass RM, McHembe MD,Matasha M, Mabula JB, et al. Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med. 2011;19(61).
Aharonson-Daniel L, Boyko V, Ziv A, Avitzour M, Peleg K. A new approach to the analysis of multiple injuries using data from a national trauma registry. Inj Prev. 2003;9(2):156.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2(7872): 81-4.
Ratcliff JJ, Adeoye O, Lindsell CJ, Hart KW, Pancioli A, McMullan JT, et al. ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: analysis of the transforming research and clinical knowledge in TBI study. Am J Emerg Med. 2014;32(8):844-50. doi: 10.1016/j.ajem.2014.04.003.
Allgöwer M, Burri C. Shock index. Dtsch Med Wochenschr. 1967;92(43):1947-50.
Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock Index in the emergency department: Utility and limitations. Open Access Emerg Med. 2019;11:179-99.
Zarzaur BL, Croce MA, Fischer PE, Magnotti LJ, Fabian TC. New vitals after injury: Shock Index for the young and Age x Shock Index for the old. J Surg Res. 2008;147(2):229-36. doi: 10.1016/j.jss. 2008.03.025.
Torabi M, Moeinaddini S, Mirafzal A, Rastegari A, Sadeghkhani N. Shock index, modifed shock index, and age shock index for prediction of mortality in emergency severity index level 3. Am J Emerg Med.2016;34(11):2079-83.
Kim SY, Hong KJ, Shin SD, Ro YS, Ahn KO, Kim YJ, et al. Validation of the Shock Index, Modifed Shock Index, and Age Shock Index for predicting mortality of geriatric trauma patients in emergency departments. J Korean Med Sci. 2016;31(12):2026-32.
Gawande AA, Kwaan MR, Regenbogen SE, Lipsitz SA, Zinner MJ. An Apgar score for surgery. J Am Coll Surg. 2007;204(2):201-8.
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.
Thevathasan T, Copeland CC, Long DR, Patrocínio MD, Friedrich S, Grabitz SD, et al. The impact of postoperative intensive care unit admission on postoperative hospital length of stay and costs: a prespecifed propensity-matched cohort study. Anesth Analg. 2019;129(3):753-61. doi: 10.1213/ANE.0000000000003946.
Siegemund M, Steiner LA. Postoperative care of the neurosurgical patient. Curr Opin Anesthesiol. 2015; 28(5):487-93. doi: 10.1097/ACO.0000000000000229.
Toccaceli A, Giampaoletti A, Dignani L, Lucertini C, Petrucci C, Lancia L. The role of shock index as a predictor of multiple-trauma patients’ pathways.Nurs Crit Care. 2016;21(2):e12-9.
Story L. Pathophysiology: a practical approach.3rd ed. Burlington, Massachusetts: Jones & Bartlett learning; 2018.
Kim S, Na S, Park S, Lee J, Kang Y-S, Jung H-h, et al. Perioperative factors for predicting the need forpostoperative intensive care after major lung resection.J Clin Med. 2019;8(744).
Kaafarani HM, Velmahos GC. Damage control resuscitation in trauma. Scand J Surg. 2014;103(2): 81-8.
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