Victor Vakayil1, Nicholas E Ingraham, Alexandria J Robbins, Rebecca Freese, Elise F Northrop, Melissa E Brunsvold, Kathryn M Pendleton, Anthony Charles, Jeffrey G Chipman, Christopher J Tignanelli. 1. From the Department of Surgery (V.V., A.J.R., M.E.B., J.G.C., C.J.T.), University of Minnesota Medical School; School of Public Health (V.V.), University of Minnesota; Department of Medicine (N.E.I., K.M.P.), University of Minnesota Medical School; Biostatistical Design and Analysis Center (R.F., E.F.N.), Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota; Department of Surgery (A.C.), and School of Public Health (A.C.), University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Surgery (C.J.T.), North Memorial Health Hospital, Robbinsdale; Institute of Health Informatics (C.J.T.), University of Minnesota, Minneapolis, Minnesota.
Abstract
BACKGROUND: Epidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs. METHODS: We performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes. RESULTS: We evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period. CONCLUSION: Temporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training. LEVEL OF EVIDENCE: Economic/decision, level IV.Epidemiologic, level IV.
BACKGROUND: Epidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs. METHODS: We performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes. RESULTS: We evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period. CONCLUSION: Temporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training. LEVEL OF EVIDENCE: Economic/decision, level IV.Epidemiologic, level IV.
Authors: Jeremy M Kahn; Christopher H Goss; Patrick J Heagerty; Andrew A Kramer; Chelsea R O'Brien; Gordon D Rubenfeld Journal: N Engl J Med Date: 2006-07-06 Impact factor: 91.245
Authors: Alexander F van der Sluijs; Eline R van Slobbe-Bijlsma; Stephen E Chick; Margreeth B Vroom; Dave A Dongelmans; Alexander P J Vlaar Journal: J Intensive Care Date: 2017-01-25
Authors: Alexandria J Robbins; Nicholas E Ingraham; Adam C Sheka; Kathryn M Pendleton; Rachel Morris; Alexander Rix; Victor Vakayil; Jeffrey G Chipman; Anthony Charles; Christopher J Tignanelli Journal: J Pain Symptom Manage Date: 2020-09-17 Impact factor: 3.612
Authors: Nicholas E Ingraham; Samantha King; Jennifer Proper; Lianne Siegel; Emily J Zolfaghari; Thomas A Murray; Victor Vakayil; Adam Sheka; Ruoying Feng; Gabriel Guzman; Samit Sunny Roy; Dhannanjay Muddappa; Michael G Usher; Jeffrey G Chipman; Christopher J Tignanelli; Kathryn M Pendleton Journal: Surg Infect (Larchmt) Date: 2021-06-15 Impact factor: 2.150