Abstract
IntroductionThe purpose of this study was to note potential gynaecological risk factors leading to intensive care and to estimate the frequency, costs and outcome of management.Materials and methodsIn a cross-sectional study of intensive care admissions in Kuopio from March 1993 to December 2000, 23 consecutive gynaecological patients admitted to a mixed medical-surgical intensive care unit (ICU) were followed. We recorded demographics, admitting diagnoses, scores on the Acute Physiological and Chronic Health Evaluation (APACHE) II, clinical outcome and treatment costs.ResultsThe overall need for intensive care was 2.3 per 1000 women undergoing major surgery during the study period. Patients were 55.4 ± 16.9 (mean ± SD) years old, with a mean APACHE II score of 14.07 (± 5.57). The most common diagnoses at admission were postoperative haemorrhage (43%), infection (39%) and cardiovascular disease (30%). The duration of stay in the ICU was 4.97 (± 9.28) (range 1–42) days and the mortality within 6 months was 26%, although the mortality in the ICU was 0%. The total cost of intensive care was approximately US$7044 per patient.ConclusionsVery few gynaecological patients develop complications requiring intensive care. The presence of gynaecological malignancy and pre-existing medical disorders are clinically useful predictors of eventual outcome, but many cases occur in women with a low risk and this implies that the risk is relevant to all procedures. Further research is needed to determine effective preventive approaches.
Highlights
The purpose of this study was to note potential gynaecological risk factors leading to intensive care and to estimate the frequency, costs and outcome of management
We retrospectively reviewed all gynaecological patients treated in the intensive care unit at Kuopio University Hospital from March 1993 to December 2000
There was no mortality in the operating theatre or in the intensive care unit (ICU), but critically ill patients beyond surgical treatment and with progressive terminal disease were not admitted to the ICU
Summary
The purpose of this study was to note potential gynaecological risk factors leading to intensive care and to estimate the frequency, costs and outcome of management. We recorded demographics, admitting diagnoses, scores on the Acute Physiological and Chronic Health Evaluation (APACHE) II, clinical outcome and treatment costs. Clinical guidelines and recommendations based on the unusual events of patient death are of little importance in medical care of the general population, and information on severe acute morbidity as evidenced by near-miss cases and utilisation of intensive care units (ICUs) may help to audit the quality of care in a more meaningful manner. The other side of the coin is that severe morbidity and the need for intensive care poorly reflect the long-term effects leading to mortality after discharge from hospital. This study was undertaken to APACHE II = Acute Physiological and Chronic Health Evaluation II; ICU = intensive care unit; IVF = in vitro fertilisation; TISS = Therapeutic Intervention Scoring System
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