title: Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients.
abstract: BACKGROUND
  An unplanned admission to the intensive care unit within 24 h of a procedure (UIA) is a recommended clinical indicator in surgical patients. Often regarded as a surrogate marker of adverse events, it has potential as a direct measure of patient safety. Its true validity for such use is currently unknown.
  
  
  METHODS
  The authors validated UIA as an indicator of safety in surgical patients in a prospective cohort study of 44,130 patients admitted to their hospital. They assessed the association of UIA with intraoperative incidents and near misses, increased hospital length of stay, and 30-day mortality as three constructs of patient safety.
  
  
  RESULTS
  The authors identified 201 patients with a UIA; 104 (52.2%) had at least one incident or near miss. After adjusting for confounders, these incidents were significantly associated with UIA in all categories of surgical procedures analyzed; odds ratios were 12.21 (95% confidence interval [CI], 6.33-23.58), 4.06 (95% CI, 2.74-6.03), and 2.13 (95% CI, 1.02-4.42), respectively. The 30-day mortality for patients with UIA was 10.9%, compared with 1.1% in non-UIA patients. After risk adjustment, UIA was associated with excess mortality in several types of surgical procedures (odds ratio, 3.89; 95% CI, 2.14-7.04). The median length of stay was increased if UIA occurred: 16 days (interquartile range, 10-31) versus 2 days (interquartile range, 0.5-9) (P < 0.001). For patients with a UIA, the likelihood of discharge from hospital was significantly decreased in most surgical categories analyzed, with adjusted hazard ratios of 0.41 (95% CI, 0.23-0.77) to 0.58 (95% CI, 0.37-0.93).
  
  
  CONCLUSIONS
  These findings provide strong support for the construct validity of UIA as a measure of patient safety.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Alfred Hospital, Monash University, Commercial Road, Melbourne, Victoria 3004, Australia. guy.haller@med.monash.edu.au
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.forename: Paul S
authors.initials: PS
authors.lastname: Myles
authors.forename: Rory
authors.initials: R
authors.lastname: Wolfe
authors.forename: Anthony M
authors.initials: AM
authors.lastname: Weeks
authors.forename: Johannes
authors.initials: J
authors.lastname: Stoelwinder
authors.forename: John
authors.initials: J
authors.lastname: McNeil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012307:Risk Factors
chemical_list: D015415:Biomarkers