Effects of the intermediate care unit on the oldest-old general surgical patients: a retrospective, pre- and postintervention study

Abstract

Whether the intermediate care unit (IMCU) is beneficial for the oldest-old (aged ≥ 80years) general surgical patients still remains unknown. We aimed to investigate the impacts of IMCU on the clinical outcomes and cost in this population. A retrospective, pre- and postintervention study was performed in this population in a university teaching hospital. The primary outcome was the occurrence of life-threatening complications including death or unplanned ICU admission after the surgeries. Secondary outcomes included the comparisons of the hospitalization expenses, the hospital length of stay (LOS) and the postoperative LOS between the pre-IMCU group and the IMCU group. Two hundred and seventeen patients were enrolled, including 98 in the pre-IMCU group and 119 in the IMCU group. After the introduction of IMCU, the occurrence of life-threatening complications significantly dropped from 11.2 to 2.5% (P = 0.012). The total hospitalization expenses showed a nonsignificant decreasing trend in the IMCU group (pre-IMCU group: 85856.3 ± 66583.7 RMB vs IMCU group: 78936.4 ± 36710.4 RMB). The treatment fee was much lower in the IMCU group (IMCU group: 4930.0 ± 4280.2 RMB vs pre-IMCU group: 7378.2 ± 10096.7 RMB, P = 0.017). Both the hospital LOS (IMCU group: 20.3 ± 10.3days vs pre-IMCU group: 19.5 ± 9.0days) and the postoperative hospital LOS (IMCU group: 12.0 ± 8.1days vs pre-IMCU group: 11.2 ± 7.0days) were not statistically different in the two groups. The allocation of the oldest-old surgical patients who do not need organ support therapy in the ICU to IMCU rather than in the standard wards was associated with a significant decrease in postoperative life-threatening complications and treatment fee. This study was registered at https://www.chictr.org.cn (ChiCTR2000030639).