Post-operative intensive care: is it really necessary?
It is estimated that more than 310 million patients receive a surgical treatment each year [1], and the number of procedures performed each year is growing [2, 3, 4, 5, 6]. Despite a majority of cases being performed without significant complication, deaths after surgery have recently been demonstrated to account for a large proportion of all deaths worldwide [7]. For a minority of patients, surgical procedures carry a significant burden of both death and disability. High-risk patients account for approximately 10–15% of the surgical population, but suffer around 80% of post-operative deaths [4, 8]. These high-risk patients have only been loosely defined, being typically older with a higher burden of comorbid disease. The surgical population is ageing at a faster rate than the background population [3]. With increasing numbers of procedures on increasingly high-risk patients, there is a clear need to identify possible interventions that improve peri-operative outcomes [4, 9], with...
Notes
Funding
RP is supported by an NIHR Research Professorship. AJF is supported by an NIHR Doctoral Research Fellowship (DRF-2018-11-ST2-062).
Compliance with ethical standards
Conflicts of interest
RP holds research grants, has given lectures, and/or performed consultancy work for Nestle Health Sciences, BBraun, Medtronic, Glaxo SmithKline, Intersurgical, and Edwards Lifesciences. All the other authors declare no conflicts of interest.
References
- 1.Weiser TG, Haynes AB, Molina G et al (2015) Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet 385:S11. https://doi.org/10.1016/S0140-6736(15)60806-6 CrossRefPubMedGoogle Scholar
- 2.Gillies MA, Sander M, Shaw A et al (2017) Current research priorities in perioperative intensive care medicine. Intensive Care Med 43:1173–1186CrossRefGoogle Scholar
- 3.Fowler AJ, Abbott TEF, Prowle J, Pearse RM (2019) Age of patients undergoing surgery. Br J Surg. https://doi.org/10.1002/bjs.11148 CrossRefPubMedGoogle Scholar
- 4.Pearse RM, Holt PJE, Grocott MPW (2011) Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ 343:d5759CrossRefGoogle Scholar
- 5.Ghaffar S, Pearse RM, Gillies MA (2017) ICU admission after surgery. Curr Opin Crit Care 23:424–429. https://doi.org/10.1097/mcc.0000000000000448 CrossRefPubMedGoogle Scholar
- 6.Edwards MR, Forbes G, MacDonald N et al (2019) Optimisation of perioperative cardiovascular management to improve surgical outcome II (OPTIMISE II) trial: study protocol for a multicentre international trial of cardiac output-guided fluid therapy with low-dose inotrope infusion compared with usual care in patients undergoing major elective gastrointestinal surgery. BMJ Open 9:e023455. https://doi.org/10.1136/bmjopen-2018-023455 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Nepogodiev D, Martin J, Biccard B et al (2019) Global burden of postoperative death. Lancet 393:401CrossRefGoogle Scholar
- 8.Pearse RM, Moreno RP, Bauer P et al (2012) Mortality after surgery in Europe: a 7 day cohort study. Lancet 380:1059–1065. https://doi.org/10.1016/S0140-6736(12)61148-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 9.Kahan BC, Koulenti D, Arvaniti K et al (2017) Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries. Intensive Care Med 43:971–979. https://doi.org/10.1007/s00134-016-4633-8 CrossRefPubMedGoogle Scholar
- 10.Pearse R, Dawson D, Fawcett J et al (2005) Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care 9:R687–R693. https://doi.org/10.1186/cc3887 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Peden CJ, Stephens T, Martin G et al (2019) Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 393:2213–2221CrossRefGoogle Scholar
- 12.Ljungqvist O, Scott M, Fearon KC (2017) Enhanced recovery after surgery a review. JAMA Surg 152:292–298. https://doi.org/10.1001/jamasurg.2016.4952 CrossRefPubMedGoogle Scholar
- 13.Gillies MA, Pearse RM (2016) Intensive care after high-risk surgery. Anesthesiology 124:761–762. https://doi.org/10.1097/aln.0000000000001025 CrossRefPubMedGoogle Scholar
- 14.Jerath A, Laupacis A, Austin PC et al (2018) Intensive care utilization following major noncardiac surgical procedures in Ontario, Canada: a population-based study. Intensive Care Med 44:1427–1435. https://doi.org/10.1007/s00134-018-5330-6 CrossRefPubMedGoogle Scholar
- 15.Gillies MA, Harrison EM, Pearse RM et al (2017) Intensive care utilization and outcomes after high-risk surgery in Scotland: a population-based cohort study. Br J Anaesth 118:123–131. https://doi.org/10.1093/bja/aew396 CrossRefPubMedGoogle Scholar
- 16.Vincent J-L, Singer M (2010) Series critical care 3 critical care: advances and future perspectives. Lancet 376:1354–1361. https://doi.org/10.1016/S0140 CrossRefPubMedGoogle Scholar
- 17.Murthy S, Wunsch H (2012) Clinical review: international comparisons in critical care-lessons learned. Crit Care 16:1–7CrossRefGoogle Scholar
- 18.Ozdemir BA, Sinha S, Karthikesalingam A et al (2016) Mortality of emergency general surgical patients and associations with hospital structures and processes. Br J Anaesth 116:54–62. https://doi.org/10.1093/bja/aev372 CrossRefPubMedGoogle Scholar
- 19.Gillies MA, Power GS, Harrison DA et al (2015) Regional variation in critical care provision and outcome after high-risk surgery. Intensive Care Med 41:1809–1816. https://doi.org/10.1007/s00134-015-3980-1 CrossRefPubMedGoogle Scholar