Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

B.C. Kahan, D. Koulenti, K. Arvaniti, V. Beavis, D. Campbell, M. Chan, R. Moreno, R.M. Pearse, R.M. Pearse, S. Beattie, P.-A. Clavien, N. Demartines, L.A. Fleisher, M. Grocott, J. Haddow, A. Hoeft, P. Holt, R. Moreno, N. Pritchard, A. RhodesD. Wijeysundera, M. Wilson, T. Ahmed, K. Everingham, R. Hewson, M. Januszewska, R.M. Pearse, M.-K. Phull, E. Lee, S. Choi, C. Chen, Y. Han, S. Yang, K. Han, C. Chen, S. Chu, C.K.E. Chung, C. Lee, Y.C. Lee, H.S. Lee, J.M. Lee, H.-M.D. Choi, C.J. Kim, S. Kim, K. Park, Y.H. Chang, J. Chang, C. Lee, G. Lee, T. Kim

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Abstract

© 2017, Springer-Verlag Berlin Heidelberg and ESICM. Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%] ; adjusted OR 3.01 [2.10–5.21]; p  < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.
Original languageEnglish
JournalIntensive Care Medicine
Volume43
Issue number7
DOIs
Publication statusPublished - 2017

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Critical Care
Survival
Mortality
Logistic Models
Perioperative Care
Berlin
Hospital Mortality
Cohort Studies

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Kahan, B.C. ; Koulenti, D. ; Arvaniti, K. ; Beavis, V. ; Campbell, D. ; Chan, M. ; Moreno, R. ; Pearse, R.M. ; Pearse, R.M. ; Beattie, S. ; Clavien, P.-A. ; Demartines, N. ; Fleisher, L.A. ; Grocott, M. ; Haddow, J. ; Hoeft, A. ; Holt, P. ; Moreno, R. ; Pritchard, N. ; Rhodes, A. ; Wijeysundera, D. ; Wilson, M. ; Ahmed, T. ; Everingham, K. ; Hewson, R. ; Januszewska, M. ; Pearse, R.M. ; Phull, M.-K. ; Lee, E. ; Choi, S. ; Chen, C. ; Han, Y. ; Yang, S. ; Han, K. ; Chen, C. ; Chu, S. ; Chung, C.K.E. ; Lee, C. ; Lee, Y.C. ; Lee, H.S. ; Lee, J.M. ; Choi, H.-M.D. ; Kim, C.J. ; Kim, S. ; Park, K. ; Chang, Y.H. ; Chang, J. ; Lee, C. ; Lee, G. ; Kim, T. / Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. In: Intensive Care Medicine. 2017 ; Vol. 43, No. 7.
@article{e9786b2bbe9447759773c117b46e6c32,
title = "Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries",
abstract = "{\circledC} 2017, Springer-Verlag Berlin Heidelberg and ESICM. Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2{\%}], standard ward: 99/39,566 patients [0.3{\%}] ; adjusted OR 3.01 [2.10–5.21]; p  < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.",
author = "B.C. Kahan and D. Koulenti and K. Arvaniti and V. Beavis and D. Campbell and M. Chan and R. Moreno and R.M. Pearse and R.M. Pearse and S. Beattie and P.-A. Clavien and N. Demartines and L.A. Fleisher and M. Grocott and J. Haddow and A. Hoeft and P. Holt and R. Moreno and N. Pritchard and A. Rhodes and D. Wijeysundera and M. Wilson and T. Ahmed and K. Everingham and R. Hewson and M. Januszewska and R.M. Pearse and M.-K. Phull and E. Lee and S. Choi and C. Chen and Y. Han and S. Yang and K. Han and C. Chen and S. Chu and C.K.E. Chung and C. Lee and Y.C. Lee and H.S. Lee and J.M. Lee and H.-M.D. Choi and C.J. Kim and S. Kim and K. Park and Y.H. Chang and J. Chang and C. Lee and G. Lee and T. Kim",
year = "2017",
doi = "10.1007/s00134-016-4633-8",
language = "English",
volume = "43",
journal = "Intensive Care Medicine",
issn = "0342-4642",
publisher = "Springer Verlag",
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Kahan, BC, Koulenti, D, Arvaniti, K, Beavis, V, Campbell, D, Chan, M, Moreno, R, Pearse, RM, Pearse, RM, Beattie, S, Clavien, P-A, Demartines, N, Fleisher, LA, Grocott, M, Haddow, J, Hoeft, A, Holt, P, Moreno, R, Pritchard, N, Rhodes, A, Wijeysundera, D, Wilson, M, Ahmed, T, Everingham, K, Hewson, R, Januszewska, M, Pearse, RM, Phull, M-K, Lee, E, Choi, S, Chen, C, Han, Y, Yang, S, Han, K, Chen, C, Chu, S, Chung, CKE, Lee, C, Lee, YC, Lee, HS, Lee, JM, Choi, H-MD, Kim, CJ, Kim, S, Park, K, Chang, YH, Chang, J, Lee, C, Lee, G & Kim, T 2017, 'Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries', Intensive Care Medicine, vol. 43, no. 7. https://doi.org/10.1007/s00134-016-4633-8

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. / Kahan, B.C.; Koulenti, D.; Arvaniti, K.; Beavis, V.; Campbell, D.; Chan, M.; Moreno, R.; Pearse, R.M.; Pearse, R.M.; Beattie, S.; Clavien, P.-A.; Demartines, N.; Fleisher, L.A.; Grocott, M.; Haddow, J.; Hoeft, A.; Holt, P.; Moreno, R.; Pritchard, N.; Rhodes, A.; Wijeysundera, D.; Wilson, M.; Ahmed, T.; Everingham, K.; Hewson, R.; Januszewska, M.; Pearse, R.M.; Phull, M.-K.; Lee, E.; Choi, S.; Chen, C.; Han, Y.; Yang, S.; Han, K.; Chen, C.; Chu, S.; Chung, C.K.E.; Lee, C.; Lee, Y.C.; Lee, H.S.; Lee, J.M.; Choi, H.-M.D.; Kim, C.J.; Kim, S.; Park, K.; Chang, Y.H.; Chang, J.; Lee, C.; Lee, G.; Kim, T.

In: Intensive Care Medicine, Vol. 43, No. 7, 2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

AU - Kahan, B.C.

AU - Koulenti, D.

AU - Arvaniti, K.

AU - Beavis, V.

AU - Campbell, D.

AU - Chan, M.

AU - Moreno, R.

AU - Pearse, R.M.

AU - Pearse, R.M.

AU - Beattie, S.

AU - Clavien, P.-A.

AU - Demartines, N.

AU - Fleisher, L.A.

AU - Grocott, M.

AU - Haddow, J.

AU - Hoeft, A.

AU - Holt, P.

AU - Moreno, R.

AU - Pritchard, N.

AU - Rhodes, A.

AU - Wijeysundera, D.

AU - Wilson, M.

AU - Ahmed, T.

AU - Everingham, K.

AU - Hewson, R.

AU - Januszewska, M.

AU - Pearse, R.M.

AU - Phull, M.-K.

AU - Lee, E.

AU - Choi, S.

AU - Chen, C.

AU - Han, Y.

AU - Yang, S.

AU - Han, K.

AU - Chen, C.

AU - Chu, S.

AU - Chung, C.K.E.

AU - Lee, C.

AU - Lee, Y.C.

AU - Lee, H.S.

AU - Lee, J.M.

AU - Choi, H.-M.D.

AU - Kim, C.J.

AU - Kim, S.

AU - Park, K.

AU - Chang, Y.H.

AU - Chang, J.

AU - Lee, C.

AU - Lee, G.

AU - Kim, T.

PY - 2017

Y1 - 2017

N2 - © 2017, Springer-Verlag Berlin Heidelberg and ESICM. Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%] ; adjusted OR 3.01 [2.10–5.21]; p  < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.

AB - © 2017, Springer-Verlag Berlin Heidelberg and ESICM. Purpose: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. Methods: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. Results: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%] ; adjusted OR 3.01 [2.10–5.21]; p  < 0.001). This association may differ with national income (high income countries OR 2.50 vs. low and middle income countries OR 4.68; p = 0.07). At hospital level, there was no association between mortality and critical care admission directly after surgery (p = 0.26), critical care admission to treat complications (p = 0.33), or provision of critical care beds (p = 0.70). Findings of the hospital-level analyses were not affected by national income status. A sensitivity analysis including only high-risk patients yielded similar findings. Conclusions: We did not identify any survival benefit from critical care admission following surgery.

U2 - 10.1007/s00134-016-4633-8

DO - 10.1007/s00134-016-4633-8

M3 - Article

VL - 43

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 7

ER -