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Adverse outcomes after planned surgery with anticipated intensive care admission in out-of-office-hours time periods: a multicentre cohort study.
- Source :
-
British journal of anaesthesia [Br J Anaesth] 2018 Jun; Vol. 120 (6), pp. 1420-1428. Date of Electronic Publication: 2018 Apr 13. - Publication Year :
- 2018
-
Abstract
- Background: Increasing mortality for patients admitted to hospitals during the weekend is a contentious but well described phenomenon. However, it remains uncertain whether adverse outcomes, including prolonged hospital length-of-stay (LOS), may also occur after patients undergoing major planned surgery are admitted to an intensive care unit (ICU) out-of-office-hours, either during weeknights (after 18:00) or on weekends.<br />Methods: All planned surgical admissions requiring admission to one of 183 ICUs across Australia and New Zealand between 2006 and 2016 were included in this retrospective population-based cohort study. Primary outcomes were hospital LOS and hospital mortality.<br />Results: Of the total 504 713 planned postoperative ICU admissions, 33.6% occurred during out-of-office-hours. After adjusting for available risk factors, out-of-office-hours ICU admissions were associated with a significant increase in hospital LOS [+2.6 days, 95% confidence interval (CI) 2.5-2.6], mortality [odd ratio (OR) 1.5, 95%CI 1.4-1.6], and a reduced chance of being directly discharged home (OR 0.8, 95%CI 0.8-0.8). The strongest association for adverse outcomes occurred with weekend ICU admissions (hospital LOS: +3.0 days, 95%CI 3.2-3.6; hospital mortality: OR 1.7, 95%CI 1.6-1.8). Clustering of adverse outcomes by hospitals was not observed in the generalised estimating equation analyses.<br />Conclusions: Despite a greater clinical staff availability and higher monitoring levels, planned surgery requiring anticipated out-of-office-hours ICU admission was associated with a prolonged hospital LOS, reduced discharge directly home, and increased mortality compared with in-office-hours admissions. Our findings have potential clinical, economic and health policy implications on how complex planned surgery should be planned and managed.<br /> (Copyright © 2018 British Journal of Anaesthesia. All rights reserved.)
- Subjects :
- APACHE
Aged
Australia epidemiology
Elective Surgical Procedures mortality
Elective Surgical Procedures statistics & numerical data
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay statistics & numerical data
Male
Middle Aged
New Zealand epidemiology
Postoperative Care methods
Postoperative Complications epidemiology
Retrospective Studies
After-Hours Care
Elective Surgical Procedures adverse effects
Patient Admission statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1471-6771
- Volume :
- 120
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- British journal of anaesthesia
- Publication Type :
- Academic Journal
- Accession number :
- 29793607
- Full Text :
- https://doi.org/10.1016/j.bja.2018.02.063