Admission to the surgical intensive care unit during intensivist coverage is associated with lower incidence of postoperative acute kidney injury and shorter ventilator time

  • Tak Kyu OhEmail author
  • In-Ae Song
  • Young-Tae Jeon
Original Article



This study aimed to assess the impact of intensivist coverage on the incidence of acute kidney injury (AKI) and ventilator time among patients postoperatively admitted to the intensive care unit (ICU).


Adult patients postoperatively admitted to the ICU between January 2012 and December 2017 were retrospectively enrolled. The incidence of AKI within 72 h of surgery and the postoperative ventilator time were compared between the groups covered by intensivists and non-intensivists.


After propensity score (PS) matching, 5650 patients were included in the final analysis (2825 patients in each group). The incidence rate of AKI was significantly higher in the non-intensivist coverage group than in the intensivist coverage group (22.7% vs. 20.2%; P = 0.023). Moreover, logistic regression analysis in the PS-matched cohort showed that the incidence of postoperative AKI in the non-intensivist coverage group increased by 16% compared to that in the intensivist coverage group (odds ratio 1.16, 95% confidence interval 1.02–1.32; P = 0.023). Additionally, the median time of ventilator use in the non-intensivist coverage group was significantly longer than that in the intensivist coverage group [7.8 (interquartile range, IQR 2.6–13.8) h vs. 5.3 (1.8–8.3) h; P < 0.001].


High-intensity intensivist coverage is associated with a lower risk of postoperative AKI and shorter postoperative ventilator times. These findings suggested that in addition to medical trainees, initial management of surgical ICU patients by intensivists may lower the risk of AKI and facilitate early weaning from mechanical ventilation.


Acute kidney injury Critical illness Intensive care units Ventilators Mechanical 



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

540_2019_2684_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)
540_2019_2684_MOESM2_ESM.docx (13 kb)
Supplementary material 2 (DOCX 14 kb)
540_2019_2684_MOESM3_ESM.docx (13 kb)
Supplementary material 3 (DOCX 14 kb)
Figure S1. Distribution of propensity scores before and after propensity score matching (TIFF 198 kb)


  1. 1.
    Besso J, Bhagwanjee S, Takezawa J, Prayag S, Moreno R. A global view of education and training in critical care medicine. Crit Care Clin. 2006;22(3):539–46 (x–xi).PubMedCrossRefGoogle Scholar
  2. 2.
    Wilcox ME, Chong CA, Niven DJ, Rubenfeld GD, Rowan KM, Wunsch H, Fan E. Do intensivist staffing patterns influence hospital mortality following ICU admission? A systematic review and meta-analyses. Crit Care Med. 2013;41(10):2253–74.PubMedCrossRefGoogle Scholar
  3. 3.
    Pronovost PJ, Angus DC, Dorman T, Robinson KA, Dremsizov TT, Young TL. Physician staffing patterns and clinical outcomes in critically ill patients: a systematic review. JAMA. 2002;288(17):2151–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Kerlin MP, Adhikari NK, Rose L, Wilcox ME, Bellamy CJ, Costa DK, Gershengorn HB, Halpern SD, Kahn JM, Lane-Fall MB, Wallace DJ, Weiss CH, Wunsch H, Cooke CR, ATS Ad Hoc Committee on ICU Organization. An Official American Thoracic Society systematic review: the effect of nighttime intensivist staffing on mortality and length of stay among intensive care unit patients. Am J Respir Crit Care Med. 2017;195(3):383–93.PubMedGoogle Scholar
  5. 5.
    Kerlin MP. 24-Hour intensivist staffing is not beneficial for patients. Crit Care Med. 2018;46(1):152–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Wallace DJ, Angus DC, Barnato AE, Kramer AA, Kahn JM. Nighttime intensivist staffing and mortality among critically ill patients. N Engl J Med. 2012;366(22):2093–101.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, Fu R, Azad T, Chao TE, Berry WR, Gawande AA. Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet. 2015;385(Suppl 2):S11.PubMedCrossRefGoogle Scholar
  8. 8.
    Jerath A, Laupacis A, Austin PC, Wunsch H, Wijeysundera DN. Intensive care utilization following major noncardiac surgical procedures in Ontario, Canada: a population-based study. Intensive Care Med. 2018;44(9):1427–35.PubMedCrossRefGoogle Scholar
  9. 9.
    Tak Kyu O, Ji E, Ahn S, Kim DJ, Song IA. Admission to surgical intensive care unit in time with intensivist coverage and its association with postoperative 30-day mortality: the role of intensivists in a surgical intensive care unit. Anaesth Crit Care Pain Med. 2019;38(3):259–63.PubMedCrossRefGoogle Scholar
  10. 10.
    Abelha FJ, Botelho M, Fernandes V, Barros H. Determinants of postoperative acute kidney injury. Crit Care. 2009;13(3):R79.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Jung YT, Kim MJ, Lee JG, Lee SH. Predictors of early weaning failure from mechanical ventilation in critically ill patients after emergency gastrointestinal surgery: a retrospective study. Medicine (Baltimore). 2018;97(40):e12741.CrossRefGoogle Scholar
  12. 12.
    Yoo S, Lee KH, Lee HJ, Ha K, Lim C, Chin HJ, Yun J, Cho EY, Chung E, Baek RM, Chung CY, Wee WR, Lee CH, Lee HS, Byeon NS, Hwang H. Seoul National University Bundang Hospital's electronic system for total care. Healthc Inform Res. 2012;18(2):145–52.PubMedPubMedCentralCrossRefGoogle Scholar
  13. 13.
    Kellum JA, Lameire N, Group KAGW. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (part 1). Crit Care. 2013;17(1):204.CrossRefGoogle Scholar
  14. 14.
    Hallan S, Asberg A, Lindberg M, Johnsen H. Validation of the modification of diet in renal disease formula for estimating GFR with special emphasis on calibration of the serum creatinine assay. Am J Kidney Dis. 2004;44(1):84–93.PubMedCrossRefGoogle Scholar
  15. 15.
    Wesselink EM, Kappen TH, Torn HM, Slooter AJC, van Klei WA. Intraoperative hypotension and the risk of postoperative adverse outcomes: a systematic review. Br J Anaesth. 2018;121(4):706–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenbaum PR, Rubin DB. Reducing bias in observational studies using subclassification on the propensity score. J Am Stat Assoc. 1984;79(387):516–24.CrossRefGoogle Scholar
  17. 17.
    O'Neal JB, Shaw AD, Billings FT. Acute kidney injury following cardiac surgery: current understanding and future directions. Crit Care. 2016;20(1):187.PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Hobson C, Ruchi R, Bihorac A. Perioperative acute kidney injury: risk factors and predictive strategies. Crit Care Clin. 2017;33(2):379–96.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Basner M, Dinges DF, Shea JA, Small DS, Zhu J, Norton L, Ecker AJ, Novak C, Bellini LM, Volpp KG. Sleep and alertness in medical interns and residents: an observational study on the role of extended shifts. Sleep. 2017. Scholar
  20. 20.
    Veasey S, Rosen R, Barzansky B, Rosen I, Owens J. Sleep loss and fatigue in residency training: a reappraisal. JAMA. 2002;288(9):1116–24.PubMedCrossRefGoogle Scholar
  21. 21.
    Grissinger M. An exhausted workforce increases the risk of errors. Pharm Ther. 2009;34(3):120–3.Google Scholar
  22. 22.
    Perren A, Brochard L. Managing the apparent and hidden difficulties of weaning from mechanical ventilation. Intensive Care Med. 2013;39(11):1885–95.PubMedCrossRefGoogle Scholar
  23. 23.
    Totonchi Z, Baazm F, Chitsazan M, Seifi S, Chitsazan M. Predictors of prolonged mechanical ventilation after open heart surgery. J Cardiovasc Thorac Res. 2014;6(4):211–6.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Kulkarni AP, Agarwal V. Extubation failure in intensive care unit: predictors and management. Indian J Crit Care Med. 2008;12(1):1–9.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2019
corrected publication 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain MedicineSeoul National University Bundang HospitalSeongnamSouth Korea
  2. 2.Department of Anesthesiology and Pain Medicine, College of MedicineSeoul National UniversitySeoulSouth Korea

Personalised recommendations