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Logistic regression was used for dichotomous outcome like mortality. Goodness of fit Chi-square test and Hosmer and Lemeshow test were applied as measures of fitness for the regression models. SICU admission rate for postoperative patients was 4. Of the surgeries performed, the rates for planned and unplanned admissions were 4. Patient characteristics, observed parameters, and their odds ratio for mortality are described in Table 1. There were Majority of trauma patients had severe head injury, and Among the patients admitted, had undergone nontraumatic abdominal surgery, 39 trauma surgery, 16 emergent neurosurgery, and three debridement.
Three surgeries were performed under regional anesthesia, two under local, and the rest under general anesthesia. As the three groups had wide variation in numbers, analysis did not illustrate any correlation with mortality. Surgeries entailing anesthesia for a period of 2—4 h were Three procedures performed under regional anesthesia could not be evaluated for the duration. No significant association could be found between the duration of surgery, duration of anesthesia, and mortality. Preoperative medical illnesses anticipated blood loss and anticipated mechanical ventilation were responsible for the majority of planned admissions while unexpected intraoperative hypotension was the principal cause of unplanned admittance [ Table 2 ].
Emergency surgeries and planned admissions were predisposed to unfavorable outcomes [ Table 1 ]. Respiratory complications were observed in Patient characteristics, operative and postoperative parameters, and odds ratio for mortality for each univariate factor. The mortality in patients with a SICU admission more than a week was Probability for longer or shorter stay for gender and GCS could not be identified [ Table 3 ]. Of the 22 readmitted patients, 16 expired in the ICU and 2 within the day period.
In-hospital mortality rate was Four out of 92 patients died in ward after being transferred. Of the discharged patients, 8. Higher admission rates were observed for males and elderly alike one previous study. The elderly besides suffering from illness such as hypertension and diabetes have poor physiological reserves to deal with postoperative complications. ASA physical status has a questionable consistency in predicting the true morbidity and mortality of a patient based on his physical condition before surgery.
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Here, it has showed an association with mortality [ Table 1 ] but could not predict the impact on the SICU length of stay, which was highlighted in some earlier reports. Mortality in postoperative trauma patients was higher Emergent acute abdominal surgeries provide little time for the optimization of vital parameters and preoperative evaluation of patients, which increases the risk of postoperative complications, and this may explain the high-mortality rate The large proportion of planned admissions in this study could have been a result of overzealous identification of emergency surgeries as high-risk procedures.
We failed to evaluate a comparable group of patients not requiring intensive care and hence failed to assess the validity of planned admissions. Despite numerous publications reporting cardiovascular and respiratory complications as main reasons for unplanned admissions, we could not conclude the same due to a very small number of unplanned admissions. Unplanned admissions represent unanticipated surgical or anesthetic intraoperative complications and failure to recognize such adverse events early could contribute to a poor outcome.
Overall survival was lower Premature discharge of patients from the SICU due to shortage of beds probably resulted in a high readmission rate 9. Prior audits have recognized the direct impact of severe illness and preoperative medical conditions on the length of SICU stay. Young patients with better risk assessment scores, patients undergoing elective surgeries or single system dysfunction and nonreadmitted patients were more likely to have a shorter duration of stay.
These low-risk groups may not require intensive care and step down units or intermediate care units can be a solution to this problem. Such indicators of poor health support the assumption that more severely ill patients require longer duration of treatment in the ICU. A large proportion of ICU resources are spent on long stay group; hence, it is prudent to recognize factors contributing to short or long SICU stay, which can assist in classifying patients into low and high-risk categories respectively.
This would prevent unwanted resource-depleting SICU admissions in developing nations.
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The day-mortality observed by Lupei et al. Multiple risk stratification models were studied in this audit, unlike other studies, to check for their association with the SICU eventuality. Sample size in spite of being relatively small was adequately powered to show correlation between perioperative variables and SICU outcomes. The number of cases with one predictor of SRCI and unplanned admissions being less, we could not reliably assess their relation with outcomes. Plastic surgery, elective neurosurgical, obstetric and gynecological, otorhinolaryngological, orthopedic, urological, vascular, and ophthalmological procedures were not evaluated.
Preoperative medical comorbidities were not individually evaluated; therefore, their correlation with poor outcomes could not be judged.
Premature discharge rate from the SICU was high due to fewer beds leading to more readmissions. There is no provision of a step down unit in our department for monitoring low-risk patients, leading to a large number of unwarranted admissions. Identification of perioperative risk factors affecting patient prognosis assists in preoperative optimization and postoperative intensive care, thus improving survival. Limiting the number of needless SICU admissions by setting up intermediate care units for monitoring low-risk patients will help save resources to manage the more critical patients effectively.
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Studies determining the impact of intermediate care units are limited at present. Provisions of an intermediate care facility for low-risk patients and an audit for the same would facilitate better postoperative care and improve patient survival. These models as well as demographic profile of the patients help in identifying high-risk patients who might require SICU admission postoperatively.
The need for postoperative critical care is significantly higher in males, elderly population, abdominal and trauma surgeries, emergency surgeries, patients with poor preoperative risk stratification scores, preexisting medical illness, major intraoperative blood loss, hypotension requiring inotropic support, and intra- or immediate post-operative respiratory problems. This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
National Center for Biotechnology Information , U.
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Indian J Crit Care Med. Shaili K. Patel , Samir M. Kacheriwala , and Dipesh D. Samir M.