SAPS 3 score as a predictive factor for postoperative referral to intensive care unit.

João M Silva,João M Silva,Helder Marcus Costa Rocha,Luiz Marcelo Sá Malbouisson,Leandro Ferreira Dias,Henrique Tadashi Katayama,Mateus Barros De Paula,Jose Maria Correa Silva,Leusi Magda Romano Andraus

doi:10.1186/s13613-016-0129-5

Abstract

BackgroundPatients undergoing intermediate-risk surgery are typically taken to the ward postoperatively. However, some may develop complications requiring intensive care later. We aimed to evaluate the characteristics of patients undergoing intermediate-risk surgery who required late postoperative admission to the intensive care unit (ICU) and determine the predictors for this.MethodsThe study included patients undergoing intermediate-risk surgery with preoperative indication for ICU but who were taken to the ward postoperatively, because they appeared to be responding well. However, they required late ICU admission. ICU care and preoperative SAPS 3 score were evaluated. Palliative surgeries and patients readmitted to ICU were excluded.ResultsThe study included 100 patients, 27 % of whom had late postoperative admission to the ICU. The preoperative SAPS 3 score was higher (45.4 ± 7.8 vs. 35.9 ± 7.4, P < 0.001) in patients who required delayed admission to the ICU postoperatively. Furthermore, they had undergone longer surgery (4.2 ± 1.9 vs. 2.7 ± 1.5 h, P < 0.001), and a greater proportion were gastrointestinal surgeries (14.8 vs. 5.5 %, P = 0.03) and intraoperative transfusion (18.5 vs. 5.5 % P = 0.04). In multivariate analysis, preoperative SAPS 3 and surgery duration independently predicted postoperative ICU admission, respectively (OR 1.25; 95 % CI 1.1–1.4 and OR 3.33; 95 % CI 1.7–6.3).ConclusionThe identification of high-risk surgical patients is essential for proper treatment; time of surgery and preoperative SAPS 3 seem to provide a useful indication of risk and may help better to characterize patients undergoing intermediate-risk surgery that demand ICU care.

Highlights

Patients undergoing intermediate-risk surgery are typically taken to the ward postoperatively
The patients included in the study were those undergoing intermediate-risk surgery, defined as those for whom an intensive care unit (ICU) bed was requested at preoperative assessment for postoperative care but who were not admitted to ICU postoperatively owing to clinical evaluation at the end of the operation
Clinical evaluation performed at the end of surgery included spontaneous breathing, a tidal volume of at Patients who had their medical records reviewed were divided into two groups, those who had an uneventful recovery in the surgical unit and those who, owing to late postoperative complications, had to be admitted to the ICU

Summary

Introduction

Patients undergoing intermediate-risk surgery are typically taken to the ward postoperatively. Some may develop complications requiring intensive care later. We aimed to evaluate the characteristics of patients undergoing intermediate-risk surgery who required late postoperative admission to the intensive care unit (ICU) and determine the predictors for this. A substantial proportion of ICU patients are surgical patients. High-risk surgical patients are not often identified as such and may experience a more difficult recovery postoperatively [1, 2]. Less than 15 % of patients who underwent those procedures were admitted to an intensive care unit (ICU), the individual risk is often underestimated and high-risk patient factors may be overlooked. Surgical patients well illustrate this point, those undergoing elective surgery [2]. It is paramount to know the predictors of the risks of increased morbidity and mortality for this group of patients [8]

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