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- Title
Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil.
- Authors
Silva Júnior, João Manoel; de Freitas Chaves, Renato Carneiro; Domingos Corrêa, Thiago; de Assunção, Murillo Santucci Cesar; Tadashi Katayama, Henrique; Eduardo Bosso, Fabio; Prata Amendola, Cristina; Serpa Neto, Ary; Sá Malbouisson, Luiz Marcelo; de Oliveira, Neymar Elias; Cordeiro Veiga, Viviane; Ordinola Rojas, Salomón Soriano; Fioravante Postalli, Natalia; Kawagoe Alvarisa, Thais; de Lucena, Bruno Melo Nobrega; de Oliveira, Raphael Augusto Gomes; Coelho Sanches, Luciana; de Andrade e Silva, Ulysses Vasconcellos; Nassar Junior, Antonio Paulo; Réa-Neto, Álvaro
- Abstract
Objective: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. Methods: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28- day postoperative, intensive care unit and hospital mortality rates were evaluated. Results: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). Conclusion: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.
- Subjects
BRAZIL; INTENSIVE care units; HOSPITAL mortality
- Publication
Revista Brasileira de Terapia Intensiva, 2020, Vol 32, Issue 1, p17
- ISSN
0103-507X
- Publication type
Article
- DOI
10.5935/0103-507X.20200005