title: Outcome of Noncardiac Surgical Patients Admitted to a Multidisciplinary Intensive Care Unit.
abstract: BACKGROUND
  Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU).
  
  
  OBJECTIVE
  We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU.
  
  
  METHODS
  This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months.
  
  
  METHODS
  Data on demography, admission Acute Physiology and Chronic Health Evaluation II (APACHE-II), Sequential Organ Failure Assessment (SOFA) scores, perioperative course, type and duration of surgery, reason for ICU admission, ICU interventions, and perioperative complications were recorded. The primary outcomes analyzed were perioperative complications and mortality.
  
  
  RESULTS
  The study included 762 patients with a mean age of (mean ± standard deviation [SD]) 50.5 ± 18 years and a male (58.4%) preponderance. The mean (±SD) admission APACHE-II and SOFA scores were 15 (±5.0) and 4.26 (±2.6), respectively. The most common reason for ICU admission was elective mechanical ventilation 50%, followed by prolonged surgery 26.2% and hemodynamic instability 21.2%. Most (51.1%) patients belonged to American Society of Anaesthesiologists physical Status III or IV and Lee's surgical risk Category I and II (66.8%). The most common surgical procedures performed were gastro-intestinal (28.5%) followed by interventional Neuro-radiology (14.0%) and orthopedic (13.9%). Overall perioperative complications were observed in 51.4% (n= 392). Common complications observed were hemodynamic instability 24%, hypothermia 17.2%, sepsis 17.3%, poor glycemic control 11.2%, perioperative myocardial infarction 7.1%, cardiac arrest 0.13%, and acute kidney injury (AKI) 10.1%. The overall hospital mortality was 7.9%. Multivariate logistic regression analysis showed that admission APACHE-II score, sepsis, AKI, and ICU length of stay were independent predictors for mortality.
  
  
  CONCLUSIONS
  High risk perioperative patients after noncardiac surgery have significant mortality and morbidity.
authors.affiliation: Department of Critical Care Medicine, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Department of Anesthesiology, Critical Care Medicine and Pain Medicine, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: M K
authors.initials: MK
authors.lastname: Renuka
authors.affiliation: Department of Critical Care Medicine, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: M S
authors.initials: MS
authors.lastname: Kalaiselvan
authors.affiliation: Department of Critical Care Medicine, Sri Ramachandra University, Chennai, Tamil Nadu, India.
authors.forename: A S
authors.initials: AS
authors.lastname: Arunkumar
keywords: Critically ill; noncardiac surgical patients; perioperative patients