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Br J Anaesth. 2018 Jun;120(6):1420-1428. doi: 10.1016/j.bja.2018.02.063. Epub 2018 Apr 13.

Adverse outcomes after planned surgery with anticipated intensive care admission in out-of-office-hours time periods: a multicentre cohort study.

Author information

1
Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia, Australia. Electronic address: davidintoronto2004@hotmail.com.
2
Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia, Australia; School of Population Health, The University of Western Australia, Perth, Western Australia, Australia; School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, Australia.
3
Department of Intensive Care Medicine, St John of God Subiaco Hospital, Perth, Western Australia, Australia.

Abstract

BACKGROUND:

Increasing mortality for patients admitted to hospitals during the weekend is a contentious but well described phenomenon. However, it remains uncertain whether adverse outcomes, including prolonged hospital length-of-stay (LOS), may also occur after patients undergoing major planned surgery are admitted to an intensive care unit (ICU) out-of-office-hours, either during weeknights (after 18:00) or on weekends.

METHODS:

All planned surgical admissions requiring admission to one of 183 ICUs across Australia and New Zealand between 2006 and 2016 were included in this retrospective population-based cohort study. Primary outcomes were hospital LOS and hospital mortality.

RESULTS:

Of the total 504 713 planned postoperative ICU admissions, 33.6% occurred during out-of-office-hours. After adjusting for available risk factors, out-of-office-hours ICU admissions were associated with a significant increase in hospital LOS [+2.6 days, 95% confidence interval (CI) 2.5-2.6], mortality [odd ratio (OR) 1.5, 95%CI 1.4-1.6], and a reduced chance of being directly discharged home (OR 0.8, 95%CI 0.8-0.8). The strongest association for adverse outcomes occurred with weekend ICU admissions (hospital LOS: +3.0 days, 95%CI 3.2-3.6; hospital mortality: OR 1.7, 95%CI 1.6-1.8). Clustering of adverse outcomes by hospitals was not observed in the generalised estimating equation analyses.

CONCLUSIONS:

Despite a greater clinical staff availability and higher monitoring levels, planned surgery requiring anticipated out-of-office-hours ICU admission was associated with a prolonged hospital LOS, reduced discharge directly home, and increased mortality compared with in-office-hours admissions. Our findings have potential clinical, economic and health policy implications on how complex planned surgery should be planned and managed.

KEYWORDS:

critical care; elective surgical procedures; perioperative care

PMID:
29793607
DOI:
10.1016/j.bja.2018.02.063

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