title: Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust.
abstract: Previous reports describe a population of non-cardiac surgical patients at high risk of complications and death. Outcomes are sub-optimal for such patients, perhaps in part related to inadequate provision or ineffective utilisation of critical care resources. In this study, data describing 26,051 in-patient non-cardiac surgical procedures performed in a large NHS Trust between April 2002 and March 2005 were extracted from local databases. Of these procedures, 2 414 (9.3%) were high risk with an overall mortality rate of 12.2% and a prolonged hospital stay (high-risk population median (IQR) 16 (9-30) days vs standard risk 3 (2-6) days). Mortality rates for specific procedures were consistent with UK averages. However, only 852 (35.3%) high-risk patients were admitted to a critical care unit at any stage after surgery. Of 294 high-risk patients who died, only 144 (49.0%) were admitted to a critical care unit at any time and only 75 (25.6%) of these deaths occurred within a critical care area. Mortality rates were high amongst patients discharged and readmitted to critical care (37.7%) and amongst those admitted to critical care following initial postoperative care on a standard ward (29.9%). These data suggest that the outcome of high-risk general surgical patients could be improved by adequate provision and more effective utilisation of critical care resources.
authors.affiliation: Barts and The London School of Medicine and Dentistry, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Jhanji
authors.forename: B
authors.initials: B
authors.lastname: Thomas
authors.forename: A
authors.initials: A
authors.lastname: Ely
authors.forename: D
authors.initials: D
authors.lastname: Watson
authors.forename: C J
authors.initials: CJ
authors.lastname: Hinds
authors.forename: R M
authors.initials: RM
authors.lastname: Pearse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003422:Critical Care / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care / Q000592:standards / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D018570:Risk Assessment; D013222:State Medicine / Q000592:standards / Q000706:statistics & numerical data