Who receives postoperative intensive and intermediate care?
OBJECTIVE
To examine the effects of preoperative and intraoperative factors that determine whether to provide postoperative intensive or intermediate care.


METHODS
Prospective observational study.


METHODS
Tertiary-care university hospital.


METHODS
3,066 ASA physical status I, II, III, and IV adult patients, 1,233 of whom were transferred to floor or the ambulatory surgery unit after a short postoperative recovery room stay (group 1), whereas the other 1,883 were admitted to intermediate and intensive care areas (group 2).


METHODS
None.


METHODS
Demographic and clinical information including preoperative medical history, extent of intraoperative care, and postoperative course were collected. Intraoperative activities were examined with the Operative Complexity Score and the Intraoperative Therapeutic Intensity Score.


RESULTS
Almost all patients undergoing complex surgery (cardiac surgery and neurosurgery) received postoperative intermediate or intensive care, even if they had no significant underlying systemic diseases (ASA physical status I and II). Patients with severe underlying diseases (ASA physical status III and IV), but who underwent less extensive surgery, tended to receive intensive and intermediate care. Postoperative mechanical ventilation was associated with receipt of intensive rather than intermediate care. Interestingly, 10% of the elective surgery patients in group 2 unexpectedly received intensive or intermediate care because of intraoperative and immediate postoperative complications.


CONCLUSIONS
Receipt of postoperative intermediate and intensive care is associated with distinct patterns of preoperative and intraoperative factors.
Weissman
Charles
C
Department of Anesthesiology and Critical Care Medicine, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel. charles@hadassah.org.il
Klein
Nava
N
D000328:Adult; D003422:Critical Care / Q000706:statistics & numerical data*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D016017:Odds Ratio; D011182:Postoperative Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012107:Research Design; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D019616:Thoracic Surgical Procedures / Q000706:statistics & numerical data; D016896:Treatment Outcome