title: SAPS 3 score as a predictive factor for postoperative referral to intensive care unit.
abstract: BACKGROUND
  Patients undergoing intermediate-risk surgery are typically taken to the ward postoperatively. However, some may develop complications requiring intensive care later. We aimed to evaluate the characteristics of patients undergoing intermediate-risk surgery who required late postoperative admission to the intensive care unit (ICU) and determine the predictors for this.
  
  
  METHODS
  The study included patients undergoing intermediate-risk surgery with preoperative indication for ICU but who were taken to the ward postoperatively, because they appeared to be responding well. However, they required late ICU admission. ICU care and preoperative SAPS 3 score were evaluated. Palliative surgeries and patients readmitted to ICU were excluded.
  
  
  RESULTS
  The study included 100 patients, 27 % of whom had late postoperative admission to the ICU. The preoperative SAPS 3 score was higher (45.4 ± 7.8 vs. 35.9 ± 7.4, P < 0.001) in patients who required delayed admission to the ICU postoperatively. Furthermore, they had undergone longer surgery (4.2 ± 1.9 vs. 2.7 ± 1.5 h, P < 0.001), and a greater proportion were gastrointestinal surgeries (14.8 vs. 5.5 %, P = 0.03) and intraoperative transfusion (18.5 vs. 5.5 % P = 0.04). In multivariate analysis, preoperative SAPS 3 and surgery duration independently predicted postoperative ICU admission, respectively (OR 1.25; 95 % CI 1.1-1.4 and OR 3.33; 95 % CI 1.7-6.3).
  
  
  CONCLUSIONS
  The identification of high-risk surgical patients is essential for proper treatment; time of surgery and preoperative SAPS 3 seem to provide a useful indication of risk and may help better to characterize patients undergoing intermediate-risk surgery that demand ICU care.
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil. joao.s@globo.com.|Anaesthesiology Department, Hospital das Clinicas SP-FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, São Paulo, SP, 05403-000, Brazil. joao.s@globo.com.
authors.forename: João M
authors.initials: JM
authors.lastname: Silva
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.
authors.forename: Helder Marcus Costa
authors.initials: HMC
authors.lastname: Rocha
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.
authors.forename: Henrique Tadashi
authors.initials: HT
authors.lastname: Katayama
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.
authors.forename: Leandro Ferreira
authors.initials: LF
authors.lastname: Dias
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.
authors.forename: Mateus Barros
authors.initials: MB
authors.lastname: de Paula
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.
authors.forename: Leusi Magda Romano
authors.initials: LMR
authors.lastname: Andraus
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.
authors.forename: Jose Maria Correa
authors.initials: JMC
authors.lastname: Silva
authors.affiliation: Hospital Servidor Publico Estadual-SP, Rua Pedro de Toledo, 1800/6º A-Vila Clementino, São Paulo, SP, 04039-901, Brazil.|Anaesthesiology Department, Hospital das Clinicas SP-FMUSP, Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, São Paulo, SP, 05403-000, Brazil.
authors.forename: Luiz Marcelo Sá
authors.initials: LMS
authors.lastname: Malbouisson
keywords: Criteria; Intensive care unit; Risk; Surgical patients