title: Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures.
abstract: BACKGROUND
  Use of intensive care after major surgical procedures and whether routinely admitting patients to intensive care units (ICUs) improve outcomes or increase costs is unknown.
  
  
  METHODS
  The authors examined frequency of admission to an ICU during the hospital stay for Medicare beneficiaries undergoing selected major surgical procedures: elective endovascular abdominal aortic aneurysm (AAA) repair, cystectomy, pancreaticoduodenectomy, esophagectomy, and elective open AAA repair. The authors compared hospital mortality, length of stay, and Medicare payments for patients receiving each procedure in hospitals admitting patients to the ICU less than 50% of the time (low use), 50 to 89% (moderate use), and 90% or greater (high use), adjusting for patient and hospital factors.
  
  
  RESULTS
  The cohort ranged from 7,878 patients in 162 hospitals for esophagectomies to 69,989 patients in 866 hospitals for endovascular AAA. Overall admission to ICU ranged from 35.6% (endovascular AAA) to 71.3% (open AAA). Admission to ICU across hospitals ranged from less than 5% to 100% of patients for each surgical procedure. There was no association between hospital use of intensive care and mortality for any of the five surgical procedures. There was a consistent association between high use of intensive care with longer length of hospital stay and higher Medicare payments only for endovascular AAA.
  
  
  CONCLUSIONS
  There is little consensus regarding the need for intensive care for patients undergoing major surgical procedures and no relationship between a hospital's use of intensive care and hospital mortality. There is also no consistent relationship across surgical procedures between use of intensive care and either length of hospital stay or payments for care.
authors.affiliation: From the Department of Critical Care Medicine and Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (H.W.); Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada (H.W.); Department of Anesthesiology, Columbia University, New York, New York (H.W., C.G., G.L.); Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, New York, New York (H.G.); Department of Medicine, University of Michigan, Ann Arbor, Michigan (C.R.C.); Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (D.C.A.); and Department of Health Policy and Management (J.W.R.) and Department of Epidemiology (G.L.), Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wunsch
authors.forename: Hayley B
authors.initials: HB
authors.lastname: Gershengorn
authors.forename: Colin R
authors.initials: CR
authors.lastname: Cooke
authors.forename: Carmen
authors.initials: C
authors.lastname: Guerra
authors.forename: Derek C
authors.initials: DC
authors.lastname: Angus
authors.forename: John W
authors.initials: JW
authors.lastname: Rowe
authors.forename: Guohua
authors.initials: G
authors.lastname: Li
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
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