Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

OBJECTIVE: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. METHODS: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., th...

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Detalles Bibliográficos
Autores principales: Silva Júnior, João Manoel, Chaves, Renato Carneiro de Freitas, Corrêa, Thiago Domingos, de Assunção, Murillo Santucci Cesar, Katayama, Henrique Tadashi, Bosso, Fabio Eduardo, Amendola, Cristina Prata, Serpa Neto, Ary, Malbouisson, Luiz Marcelo Sá, de Oliveira, Neymar Elias, Veiga, Viviane Cordeiro, Rojas, Salomón Soriano Ordinola, Postalli, Natalia Fioravante, Alvarisa, Thais Kawagoe, de Lucena, Bruno Melo Nobrega, de Oliveira, Raphael Augusto Gomes, Sanches, Luciana Coelho, Silva, Ulysses Vasconcellos de Andrade e, Nassar Junior, Antonio Paulo, Réa-Neto, Álvaro, Amaral, Alexandre, Teles, José Mário, de Freitas, Flávio Geraldo Rezende, Bafi, Antônio Tonete, Pacheco, Eduardo Souza, Ramos, Fernando José, Vieira Júnior, José Mauro, Pereira, Maria Augusta Santos Rahe, Schwerz, Fábio Sartori, de Menezes, Giovanna Padoa, Magalhães, Danielle Dourado, Castro, Cristine Pilati Pileggi, Henrich, Sabrina Frighetto, Toledo, Diogo Oliveira, Parra, Bruna Fernanda Camargo Silva, Dias, Fernando Suparregui, Zerman, Luiza, Formolo, Fernanda, Nobrega, Marciano de Sousa, Piras, Claudio, Piras, Stéphanie de Barros, Conti, Rodrigo, Bittencourt, Paulo Lisboa, D’Oliveira, Ricardo Azevedo Cruz, Estrela, André Ricardo de Oliveira, de Oliveira, Mirella Cristine, Reese, Fernanda Baeumle, Motta Júnior, Jarbas da Silva, da Câmara, Bruna Martins Dzivielevski, David-João, Paula Geraldes, Tannous, Luana Alves, Chaiben, Viviane Bernardes de Oliveira, Miranda, Lorena Macedo Araújo, Brasil, José Arthur dos Santos, Deucher, Rafael Alexandre de Oliveira, Ferreira, Marcos Henrique Borges, Vilela, Denner Luiz, de Almeida, Guilherme Cincinato, Nedel, Wagner Luis, dos Passos, Matheus Golenia, Marin, Luiz Gustavo, de Oliveira Filho, Wilson, Coutinho, Raoni Machado, de Oliveira, Michele Cristina Lima, Friedman, Gilberto, Meregalli, André, Höher, Jorge Amilton, Soares, Afonso José Celente, Lobo, Suzana Margareth Ajeje
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Associação de Medicina Intensiva Brasileira - AMIB 2020
Materias:
Original Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206944/
https://www.ncbi.nlm.nih.gov/pubmed/32401988
http://dx.doi.org/10.5935/0103-507X.20200005
Descripción
Sumario:OBJECTIVE: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. METHODS: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. RESULTS: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). CONCLUSION: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.

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