Background

The appropriate level of postoperative critical care for patients undergoing emergency surgery is unknown. We aimed to assess the outcomes of postoperative patients treated in the intensive care unit (ICU) and high dependency care unit (HDU) after emergency surgery.

Methods

Analysis of national in-patient registry data in Japan from July 2010 to March 2018, including patients undergoing one of 10 emergency surgeries on the day of hospital admission. The exposures were ICU or HDU admission on the day of surgery. The primary outcome was in-hospital mortality. We performed multivariable logistic regression analysis adjusted for patient and hospital characteristics. Results are presented as n (%) and odds ratios (ORs) with 95% confidence intervals.

Results

We included 158 149 patients from 646 hospitals. Crude in-hospital mortality for each procedure ranged from 168/8583 (2.0%) for cholecystectomy to 2842/12 958 (21.9%) for patients undergoing surgery for traumatic brain injury. Compared with HDU admission, ICU admission was associated with lower in-hospital mortality among the cohorts for medium-mortality risk procedures (procedure-specific mortality 5–15%) (ICU: 8834/73 616 [12.0%] vs HDU: 2586/25 262 [10.2%]; OR=0.90 [0.85–0.96]; P=0.001), and high-mortality risk procedures (procedures-specific mortality >15%) (ICU: 3445/16 334 [21.1%] vs HDU: 996/4613 [21.6%]; OR=0.86 [0.78–0.96]; P=0.005). There were no differences in mortality for low-mortality risk procedures with procedure-specific mortality <5%.

Conclusions

In this national registry study, postoperative critical care in ICU was associated with lower in-hospital mortality than in HDU for patients undergoing medium-risk and high-risk emergency surgery. Further research is needed to understand the role of critical care for surgical patients.

中文翻译：

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急诊手术后重症监护病房与高度依赖监护病房入院：一项全国住院登记研究

背景

对接受急诊手术的患者来说，适当的术后重症监护水平尚不清楚。我们旨在评估急诊手术后在重症监护病房 (ICU) 和高度依赖监护病房 (HDU) 接受治疗的术后患者的结果。

方法

分析日本 2010 年 7 月至 2018 年 3 月的全国住院登记数据，包括入院当天接受 10 次紧急手术之一的患者。暴露是在手术当天入住 ICU 或 HDU。主要结局是住院死亡率。我们进行了针对患者和医院特征进行调整的多变量逻辑回归分析。结果显示为n (%) 和优势比 (ORs)，置信区间为 95%。

结果

我们纳入了来自 646 家医院的 158 149 名患者。每种手术的粗住院死亡率从胆囊切除术的 168/8583 (2.0%) 到因创伤性脑损伤接受手术的患者的 2842/12 958 (21.9%) 不等。与 HDU 入院相比，ICU 入院与中等死亡率风险手术队列中较低的住院死亡率相关（手术特定死亡率 5-15%）（ICU：8834/73 616 [12.0%] vs HDU：2586/ 25 262 [10.2%]；OR=0.90 [0.85–0.96]；P = 0.001）和高死亡率风险程序（程序特定死亡率>15%）（ICU：3445/16 334 [21.1%] vs HDU： 996/4613 [21.6%]；OR=0.86 [0.78–0.96]；P=0.005)。手术特异性死亡率<5%的低死亡率风险手术的死亡率没有差异。

结论

在这项国家登记研究中，对于接受中危和高危急诊手术的患者，ICU 的术后重症监护与住院死亡率低于 HDU 相关。需要进一步的研究来了解重症监护对外科患者的作用。