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Br J Anaesth. 2019 Jan;122(1):42-50. doi: 10.1016/j.bja.2018.07.029. Epub 2018 Sep 20.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study.

Collaborators (1166)

McLean KA, Glasbey JC, Borakati A, Brooks TM, Chang HM, Choi SM, Goodson R, Nielsen M, Pronin S, Salloum NL, Sewart E, Vanniasegaram D, Drake TM, Gillies MA, Harrison EM, Chapman SJ, Khatri C, Kong CY, Claireaux HA, Bath MF, Mohan M, McNamee L, Kelly M, Mitchell H, Fitzgerald JE, Bhangu A, Nepogodiev D, Antoniou I, Dean R, Davies N, Trecarten S, Henderson I, Holmes C, Wylie J, Shuttleworth RH, Jindal A, Hughes F, Gouda P, Fleck R, Hanrahan M, Karunakaran P, Chen JH, Sykes MC, Sethi RK, Suresh S, Patel P, Patel M, Varma RK, Mushtaq J, Gundogan B, Bolton W, Khan T, Burke J, Morley R, Favero N, Adams R, Thirumal V, Kennedy ED, Ong KK, Tan YH, Gabriel J, Bakhsh A, Low JYL, Yener A, Paraoan V, Preece R, Tilston TW, Cumber E, Dean S, Ross T, McCance E, Amin H, Satterthwaite L, Clement KD, Gratton R, Mills ED, Chiu SM, Hung G, Rafiq NM, Hayes JDB, Robertson KL, Dynes K, Huang HC, Assadullah S, Duncumb JW, Moon RDC, Poo SX, Mehta JK, Joshi KR, Callan R, Norris JM, Chilvers NJ, Keevil H, Jull P, Mallick S, Elf D, Carr L, Player C, Barton EC, Martin AL, Ratu SG, Roberts EJ, Phan PN, Dyal AR, Rogers JE, Henson AD, Reid NB, Burke D, Culleton G, Lynne S, Mansoor S, Brennan C, Blessed R, Holloway C, Hill A, Goldsmith T, Mackin S, Kim S, Woin E, Brent G, Coffin J, Ziff O, Momoh Z, Debenham R, Ahmed M, Yong CS, Wan JC, Copley HC, Raut P, Chaudhry FI, Nixon G, Dorman C, Tan R, Kanabar S, Canning N, Dolaghan M, Bell N, McMenamin M, Chhabra A, Duke K, Turner L, Patel T, Chew LS, Mirza M, Lunawat S, Oremule B, Ward N, Khan M, Tan ET, Maclennan D, McGregor RJ, Chisholm EG, Griffin EJ, Bell L, Hughes BA, Davies J, Haq H, Ahmed H, Ungcharoen N, Whacha C, Thethi R, Markham RM, Lee AHY, Batt E, Bullock NP, Francescon CT, Davies JE, Shafiq NM, Zhao J, Vivekanantham S, Barai I, Allen JLY, Marshall DC, McIntyre CJ, Wilson HCP, Ashton AJ, Lek C, Behar N, Davis-Hall M, Seneviratne N, Esteve L, Sirakaya M, Ali S, Pope S, Ahn JS, Craig-McQuaide A, Gatfield WA, Leong S, Demetri AM, Kerr AL, Rees C, Loveday J, Liu S, Wijesekera M, Maru D, Attalla M, Smith N, Brown D, Sritharan P, Shah A, Charavanamuttu V, Heppenstall-Harris G, Ng K, Raghvani T, Rajan N, Hulley K, Moody N, Williams M, Cotton A, Sharifpour M, Lwin KN, Bright M, Chitnis AR, Abdelhadi M, Semana AD, Morgan F, Reid R, Dickson J, Anderson L, McMullan R, Ahern N, Asmadi A, Anderson LB, Boon Xuan JL, Crozier L, McAleer S, Lees DM, Adebayo AA, Das M, Amphlett AH, Al-Robeye A, Valli A, Khangura J, Winarski A, Ali A, Woodward H, Gouldthrope C, Turner M, Sasapu K, Tonkins M, Wild JRL, Robinson M, Hardie J, Heminway R, Narramore R, Ramjeeawon N, Hibberd A, Winslow F, Ho W, Chong BF, Lim K, Ho S, Crewdson JA, Singagireson S, Kalra N, Koumpa F, Jhala H, Soon WC, Karia M, Rasiah MG, Xylas D, Gilbert H, Sundar-Singh M, Wills J, Akhtar S, Patel S, Hu L, Brathwaite-Shirley C, Nayee H, Amin O, Rangan T, Turner EJH, McCrann C, Shepherd R, Patel N, Prest-Smith J, Auyoung E, Murtaza A, Coates A, Prys-Jones O, King M, Gaffney S, Dewdney CJ, Nehikhare I, Lavery J, Bassett J, Davies K, Ahmad K, Collins A, Acres M, Egerton C, Cheng K, Chen X, Chan N, Sheldon A, Khan S, Empey J, Ingram E, Malik A, Johnstone M, Goodier R, Shah JP, Giles JE, Sanders JA, McLure SW, Pal S, Rangedara A, Baker AN, Asbjoernsen CA, Girling C, Gray L, Gauntlett L, Joyner C, Qureshi S, Mogan YP, Ng JCK, Kumar AN, Park JH, Tan D, Choo KP, Raman KP, Buakuma P, Xiao C, Govinden S, Thompson OD, Charalambos MA, Brown E, Karsan RB, Dogra T, Bullman LM, Dawson PM, Frank AL, Abid H, Tung L, Qureshi U, Tahmina A, Matthews BW, Harris RT, O'Connor A, Mazan K, Iqbal S, Stanger SA, Thompson JD, Sullivan JAL, Uppal E, MacAskill A, Bamgbose FA, Neophytou C, Carroll AF, Rookes CW, Datta U, Dhutia AJ, Rashid S, Ahmed N, Lo T, Bhanderi S, Blore CD, Ahmed S, Shaheen H, Abburu S, Majid S, Abbas Z, Talukdar SS, Burney LJ, Patel JB, Al-Obaedi O, Roberts AW, Mahboob S, Singh B, Sheth S, Karia P, Prabhudesai A, Kow K, Koysombat K, Wang S, Morrison P, Maheswaran Y, Keane P, Copley PC, Brewster O, Xu GX, Harries P, Wall C, Al-Mousawi A, Bonsu S, Cunha P, Ward T, Paul J, Nadanakumaran K, Tayeh S, Holyoak H, Remedios J, Theodoropoulou K, Luhishi A, Jacob L, Long F, Atayi A, Sarwar S, Parker O, Harvey J, Ross H, Rampal R, Thomas G, Vanmali P, McGowan C, Stein J, Robertson V, Carthew L, Teng V, Fong J, Street AN, Thakker CE, O'Reilly D, Bravo M, Pizzolato A, Khokhar HA, Ryan M, Cheskes L, Carr R, Salih AE, Bassiony S, Yuen R, Chrastek D, Rosen O'Sullivan H, Amajuoyi A, Wang A, Sitta O, Wye J, Qamar MA, Major C, Kaushal A, Morgan C, Petrarca M, Allot R, Verma K, Dutt S, Chilima CP, Peroos S, Kosasih SR, Chin H, Ashken L, Pearse RJ, O'Loughlin RA, Menon A, Singh K, Norton J, Sagar R, Jathanna N, Rothwell L, Watson N, Harding F, Dube P, Khalid H, Punjabi N, Sagmeister M, Gill P, Shahid S, Hudson-Phillips S, George D, Ashwood J, Lewis T, Dhar M, Sangal P, Rhema IA, Kotecha D, Afzal Z, Syeed JA, Prakash E, Jalota P, Herron J, Kimani L, Delport A, Shukla A, Agarwal V, Parthiban S, Thakur H, Cymes W, Rinkoff S, Turnbull JA, Hayat M, Darr S, Khan U, Lim J, Higgins A, Lakshmipathy G, Forte B, Canning E, Jaitley A, Lamont J, Toner E, Ghaffar A, McDowell M, Salmon D, O'Carroll O, Khan A, Kelly ME, Clesham K, Palmer C, Lyons R, Bell A, Chin R, Waldron RM, Trimble A, Cox SE, Ashfaq U, Campbell J, Holliday RBS, McCabe G, Morris F, Priestland R, Vernon OK, Ledsam A, Vaughan R, Lim D, Bakewell ZR, Hughes RK, Koshy RM, Jackson HR, Narayan P, Cardwell AE, Jubainville CL, Arif T, Elliott LE, Gupta V, Bhaskaran G, Odeleye A, Ahmed F, Shah R, Pickard J, Suleman YN, North AS, McClymont LF, Hussain N, Ibrahim I, Ng GS, Wong V, Lim AE, Harris LN, Tharmachandirar T, Mittapalli D, Patel V, Lakhani M, Bazeer HZ, Narwani V, Sandhu KK, Wingfield LR, Gentry S, Adjei H, Bhatti M, Braganza L, Barnes J, Mistry S, Chillarge G, Stokes S, Cleere J, Wadanamby S, Bucko AM, Meek J, Boxall N, Heywood EG, Wiltshire JJ, Toh C, Ward AE, Shurovi BN, Horth D, Patel BY, Ali B, Spencer T, Axelson T, Kretzmer L, Chhina C, Anandarajah C, Fautz T, Horst C, Thevathasan AA, Ng JQ, Hirst F, Brewer CF, Logan AE, Lockey JW, Forrest PR, Keelty N, Wood AD, Springford LR, Avery P, Schulz TM, Bemand TP, Howells L, Collier H, Khajuria A, Tharakan RG, Parsons S, Buchan AM, McGalliard RJ, Mason JD, Cundy OJ, Li N, Redgrave NA, Watson RP, Pezas TP, Dennis YF, Segall E, Hameed M, Lynch AS, Chamberlain M, Peck FS, Neo YN, Russell G, Elseedawy M, Lee S, Foster NL, Soo YH, Puan L, Dennis R, Goradia H, Qureshi A, Osman S, Reeves T, Dinsmore L, Marsden M, Lu Q, Pitts-Tucker T, Dunn CE, Walford RA, Heathcote E, Martin R, Pericleous A, Brzyska K, Reid KG, Williams MR, Wetherall N, McAleer E, Thomas D, Kiff R, Milne S, Holmes MJV, Bartlett J, Lucas de Carvalho J, Bloomfield T, Tongo F, Bremner RH, Yong N, Atraszkiewicz BA, Mehdi A, Tahir M, Sherliker GXJ, Tear AK, Pandey A, Broyd A, Omer HM, Raphael M, Chaudhry WW, Shahidi S, Jawad AS, Gill CK, Fisher IH, Adeleja I, Clark IJ, Aidoo-Micah GE, Stather PW, Salam GJ, Glover TE, Deas G, Sim NK, Obute RD, Wynell-Mayow WM, Sait MS, Mitha N, de Bernier GL, Siddiqui M, Shaunak R, Wali A, Cuthbert G, Bhudia R, Webb E, Shah S, Ansari N, Perera M, Kelly N, McAllister R, Stanley GH, Keane CP, Shatkar V, Maxwell-Armstrong C, Henderson LA, Maple N, Manson R, Adams RD, Semple E, Mills M, Daoub A, Marsh A, Ramnarine A, Hartley J, Malaj M, Jewell PD, Whatling EA, Hitchen N, Chen M, Goh B, Fern J, Rogers S, Derbyshire L, Robertson DT, Abuhussein N, Deekonda P, Abid A, Harrison PLM, Aildasani L, Turley H, Sherif MA, Pandey G, Filby JJ, Johnston A, Burke E, Mohamud M, Gohil K, Tsui AY, Singh R, Lim SJ, O'Sullivan K, McKelvey LL, O'Neill S, Roberts HF, Brown FS, Cao Y, Buckle RT, Liew Y, Sii S, Ventre CM, Graham CJ, Filipescu T, Yousif A, Dawar R, Wright A, Peters M, Varley R, Owczarek S, Hartley S, Khattak M, Iqbal A, Ali M, Durrani B, Narang Y, Bethell GS, Horne L, Pinto R, Nicholls K, Kisyov I, Torrance HD, English W, Lakhani SM, Ashraf SF, Venn M, Elangovan V, Kazmi Z, Brecher J, Sukumar S, Mastan A, Mortimer A, Parker J, Boyle J, Elkawafi M, Beckett J, Mohite A, Narain A, Mazumdar E, Sreh A, Hague A, Weinberg D, Fletcher L, Steel M, Shufflebotham H, Masood M, Sinha Y, Jenvey C, Kitt H, Slade R, Craig AR, Deall C, Reakes T, Chervenkoff J, Strange E, O'Bryan M, Murkin C, Joshi D, Bergara T, Naqib S, Wylam D, Scotcher SE, Hewitt CM, Stoddart MT, Kerai A, Trist AJ, Cole SJ, Knight CL, Stevens S, Cooper GE, Ingham R, Dobson J, O'Kane A, Moradzadeh J, Duffy A, Henderson C, Ashraf S, McLaughin C, Hoskins TC, Reehal RS, Bookless LR, McLean RC, Stone EJ, Wright EV, Abdikadir HR, Roberts C, Spence O, Srikantharajah M, Ruiz EM, Matthews JH, Gardner E, Hester E, Naran P, Simpson R, Minhas M, Cornish E, Semnani SA, Rojoa D, Radotra A, Eraifej J, Eparh K, Smith DNE, Mistry BD, Hickling SL, Din W, Liu C, Mithrakumar P, Mirdavoudi V, Rashid M, Mcgenity C, Hussain O, Kadicheeni M, Gardner H, Anim-Addo N, Pearce J, Aslanyan A, Ntala C, Sorah T, Parkin J, Alizadeh M, White A, Edozie F, Johnston J, Kahar A, Navayogaarajah V, Patel B, Carter D, Khonsari P, Burgess A, Kong C, Ponweera A, Cody A, Tan Y, Ng AYL, Croall A, Allan C, Ng S, Raghuvir V, Telfer R, Greenhalgh AD, McKerr CN, Edison MA, Patel BA, Dear K, Hardy MR, Williams P, Hassan S, Sajjad U, O'Neill EM, Lopes S, Healy L, Jamal N, Tan S, Lazenby D, Husnoo SB, Beecroft S, Sarvanandan T, Weston C, Bassam N, Rabinthiran S, Hayat U, Ng L, Varma D, Sukkari M, Mian A, Omar A, Kim JW, Sellathurai J, Mahmood J, O'Connell C, Bose R, Heneghan H, Lalor P, Matheson J, Doherty C, Cullen C, Cooper D, Angelov S, Drislane C, Smith ACD, Kreibich A, Palkhi E, Durr A, Lotfallah A, Gold D, Mckean E, Dhanji A, Anilkumar A, Thacoor A, Siddiqui ZH, Lim S, Piquet A, Anderson SM, McCormack DR, Gulati J, Ibrahim A, Murray SE, Walsh SL, McGrath A, Ziprin P, Chua EY, Lou CN, Bloomer J, Paine HR, Osei-Kuffour D, White CJ, Szczap A, Gokani S, Patel K, Malys MK, Reed A, Torlot GE, Cumber EM, Charania A, Ahmad S, Varma N, Cheema H, Austreng L, Petra H, Chaudhary M, Zegeye MI, Cheung F, Coffey D, Heer RS, Singh S, Seager E, Cumming S, Suresh RS, Verma S, Ptacek IB, Gwozdz AM, Yang T, Khetarpal AA, Shumon S, Fung TMP, Leung W, Kwang P, Chew L, Loke W, Curran A, Chan C, McGarrigle C, Mohan K, Cullen S, Wong E, Toale C, Collins D, Keane N, Traynor BP, Shanahan D, Yan A, Jafree DJ, Topham C, Mitrasinovic S, Omara S, Bingham G, Lykoudis PM, Miranda BH, Whitehurst K, Kumaran G, Devabalan Y, Aziz H, Shoa M, Dindyal S, Yates JA, Bernstein I, Rattan G, Coulson R, Stezaker S, Isaac A, Salem M, McBride A, McFarlane H, Yow L, MacDonald J, Bartlett RD, Turaga S, White U, Liew W, Yim N, Ang A, Simpson A, McAuley D, Craig E, Murphy L, Shepherd P, Kee JY, Abdulmajid A, Chung A, Warwick HL, Livesey A, Holton P, Theodoreson MD, Jenkin SL, Turner J, Entwisle JH, Marchal ST, O'Connor S, Blege HK, Aithie JM, Sabine LM, Stewart GE, Jackson S, Kishore A, Lankage CM, Acquaah F, Joyce HL, McKevitt KL, Coffey CJ, Fawaz AS, Dolbec KS, O'Sullivan DA, Geraghty JM, Lim E, Bolton L, FitzPatrick D, Robinson C, Ramtoola T, Collinson S, Grundy L, McEnhill PM, Harbhajan Singh GS, Loughran D, Golding DM, Keeling RE, Williams RP, Whitham RDJ, Yoganathan S, Nachiappan R, Egan RJ, Owasil R, Kwan ML, He A, Goh RW, Bhome R, Wilson H, Teoh PJ, Raji K, Jayakody N, Matthams J, Chong J, Luk CY, Greig RJ, Trail M, Charalambous G, Rocke AS, Gardiner N, Bulley F, Warren N, Brennan E, Fergurson P, Wilson R, Whittingham H, Brown EJ, Khanijau R, Gandhi K, Morris S, Boulton AJ, Chandan N, Barthorpe AE, Maamari R, Sandhu S, McCann M, Higgs L, Balian V, Reeder C, Diaper C, Sale T, Ali H, Archer CH, Clarke AK, Heskin J, Hurst PC, Farmer JD, O'Flynn LD, Doan L, Shuker BA, Stott GD, Vithanage NA, Hoban KA, Nesargikar PN, Kennedy HR, Grossart CM, Tan ESM, Roy CSD, Sim P, Leslie KE, Sim D, Abul MH, Cody N, Tay AY, Woon E, Sng S, Mah J, Robson J, Shakweh E, Wing VC, Mills H, Li MM, Barrow TR, Balaji S, Jordan HEM, Phillips C, Naveed H, Hirani S, Tai A, Ratnakumaran R, Sahathevan A, Shafi AMA, Seedat M, Weaver R, Batho A, Punj R, Selvachandran H, Bhatt N, Botchey S, Khonat Z, Brennan K, Morrison CJ, Devlin E, Linton A, Galloway E, McGarvie S, Ramsay N, McRobbie HD, Whewell H, Dean W, Nelaj S, Eragat M, Mishra A, Kane T, Zuhair M, Wells M, Wilkinson D, Woodcock N, Sun E, Aziz N, Ghaffar MKA.

Abstract

BACKGROUND:

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS:

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS:

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS:

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

KEYWORDS:

critical care; gastrointestinal surgery; intensive care; laparotomy; mortality; risk surgical

PMID:
30579405
DOI:
10.1016/j.bja.2018.07.029
[Indexed for MEDLINE]

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