title: Life-threatening complications after postoperative intermediate care unit discharge: A retrospective, observational study.
abstract: BACKGROUND
  Postoperative patients who require intensive monitoring, intervention with an arterial line, vasoactive drugs and prolonged ventilator weaning are admitted to the postoperative intermediate care unit (IMCU).
  
  
  OBJECTIVE
  The aim of this study was to estimate the prevalence of life-threatening complications within 7 days after IMCU discharge. Furthermore, we searched for associations between perioperative risk factors and these life-threatening complications.
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  The postoperative IMCU of a university hospital in Tokyo, Japan, between 2010 and 2012.
  
  
  METHODS
  All adult patients who stayed in the postoperative IMCU and who were discharged to general wards without being transferred to the ICU were included.
  
  
  METHODS
  A composite outcome of life-threatening complications needing unplanned ICU admission within 7 days after IMCU stay, or death within 7 days after IMCU stay.
  
  
  RESULTS
  Forty out of 3093 patients (1.3%) presented a life-threatening complication; all had an unplanned ICU admission, and none died. Patients with life-threatening complications had a longer length of hospital stay [median 38.0 (interquartile range, IQR 21.3 to 56.8) days vs. 12.0 (IQR 8.0 to 23.0), P < 0.001] and a higher in-hospital mortality (12.5 vs. 0.7%, P < 0.001). Independent risk factors were an emergency operation before IMCU admission [vs. elective; odds ratio (OR) 20.5; 95% confidence interval (95% CI) 12.2 to 36.0, P < 0.001], higher cumulative perioperative fluid load during the surgical operation and IMCU stay (3000 to 4999 vs. <1000 ml; OR 5.7; 95% CI 1.6 to 23.7, P = 0.009; ≥5000 vs. <1000 ml; OR 7.2; 95% CI 1.3 to 39.6, P = 0.021), mechanical ventilation during IMCU stay less than 6 h (vs. no use; OR 3.6; 95% CI 1.4 to 9.2, P = 0.007).
  
  
  CONCLUSIONS
  More than 1% of patients had a life-threatening complication within 7 days after IMCU discharge, but with no deaths. Risk factors were an emergency operation before IMCU admission, higher cumulative perioperative fluid load and a short period of mechanical ventilation during the IMCU stay.
authors.affiliation: From the Intensive Care Unit, Department of Anaesthesiology, the Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Fujii
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Uchino
authors.forename: Masanori
authors.initials: M
authors.lastname: Takinami
mesh_terms: D000368:Aged; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011182:Postoperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000503:physiopathology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors