Incidence of Postoperative Intensive Care Admissions in Elective Surgical Patients with High-Risk Anaesthesia Consent Preoperatively

Abstract

Introduction: Surgical patients who require high-risk anaesthesia consent are often at risk of developing perioperative complications and morbidity often warranting postoperative Intensive Care Unit (ICU) admissions. Aim: To study the incidence of postoperative ICU admissions among surgical patients who require high-risk anaesthesia consent preoperatively. Materials and Methods: A retrospective study using chart analysis of 64 patients who required high-risk consent for elective surgery over a period of 18 months from January 2018 to July 2019 was done. The details on demographics, the American Society of Anaesthesiologists (ASA) class, the reason for obtaining high-risk consent, type of anaesthesia administered, intraoperative events, duration of surgery and reason for shifting to Intensive Care Unit (ICU) was collected and recorded. Statistical analysis was performed with the Statistical Package for the Social Sciences (SPSS) software, version 20.0. Multiple logistic regressions were performed to determine the predictors of postoperative ICU admissions. Results: Out of 64 high-risk patients, 35.9% of patients were shifted to ICU postoperatively, with the most common reason for ICU admission being metabolic/haemodynamic instability intraoperatively (47.8%). Among the various preoperative factors (presence of cardiovascular, respiratory diseases with poor reserve or functional impairment, chronic kidney disease, morbid obesity) for obtaining high-risk consent, anticipated long duration surgery with blood loss was associated with a 3.9 {95 % CIs of 1.25 and 12.22} times higher odds of being shifted to ICU postoperatively. Conclusion: About one-third of elective surgical patients who required high-risk anaesthesia consent preoperatively required ICU admission postoperatively. In addition, anticipated long duration surgery with blood loss was found to be an independent predictor of ICU requirement postoperatively.

Keywords

• elective surgical procedure
• informed consent
• intensive care unit
• surgical blood loss