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Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil

2020; Associação de Medicina Intensiva Brasileira; Volume: 32; Issue: 1 Linguagem: Inglês

10.5935/0103-507x.20200005

1982-4335

João Manoel Silva, Renato Carneiro de Freitas Chaves, Thiago Domingos Corrêa, Murillo Santucci César de Assunção, Henrique Tadashi Katayama, Fabio Eduardo Bosso, Cristina Prata Amêndola, Ary Serpa Neto, Luíz Marcelo Sá Malbouisson, Neymar Elias de Oliveira, Viviane Cordeiro Veiga, Salomón Soriano Ordinola Rojas, Natalia Fioravante Postalli, Thais Kawagoe Alvarisa, Bruno Melo Nóbrega de Lucena, Raphael Augusto Gomes de Oliveira, Luciana Coelho Sanches, Ulysses Vasconcellos de Andrade e Silva, Antônio Paulo Nassar, Álvaro Réa-Neto, Alexandre Amaral, José Teles, Flávio Geraldo Rezende Freitas, Antônio Tonete Bafi, Eduardo Souza Pacheco, Fernando José Ramos, José Mauro Vieira, Maria Augusta Santos Rahe Pereira, Fábio Sartori Schwerz, Giovanna Pádoa de Menezes, Danielle Dourado Magalhães, Cristine Pilati Pileggi Castro, Sabrina Frighetto Henrich, Diogo Oliveira Toledo, Bruna Fernanda Camargo Silva Parra, Fernando Suparregui Dias, L. Zerman, Fernanda Formolo, Marciano de Sousa Nóbrega, Cláudio Piras, Stéphanie de Barros Piras, Rodrigo Conti, Paulo Lisboa Bittencourt, Ricardo Azevedo Cruz D’Oliveira, André Ricardo de Oliveira Estrela, Mirella Cristine de Oliveira, Fernanda Baeumle Reese, Jarbas da Silva Motta Júnior, B Camara, Paula Geraldes David-João, Luana Alves Tannous, Viviane Bernardes de Oliveira Chaiben, Lorena Macedo Araújo Miranda, José Arthur dos Santos Brasil, Rafael Alexandre de Oliveira Deucher, Marcos Henrique Borges Ferreira, Denner Luiz Vilela, Guilherme C. Almeida, Wagner Luís Nedel, Matheus Golenia dos Passos, Luiz Gustavo Marin, Wilson de Oliveira Filho, Raoni Machado Coutinho, Michele Cristina Lima de Oliveira, Gilberto Friedman, A. Meregalli, Jorge Amilton Höher, Afonso José Celente Soares, Suzana Margareth Lobo,

Sepsis Diagnosis and Treatment

OBJECTIVE: To define the epidemiological profile and the main determinants of morbidity and mortality in noncardiac high surgical risk patients in Brazil. METHODS: This was a prospective, observational and multicenter study. All noncardiac surgical patients admitted to intensive care units, i.e., those considered high risk, within a 1-month period were evaluated and monitored daily for a maximum of 7 days in the intensive care unit to determine complications. The 28-day postoperative, intensive care unit and hospital mortality rates were evaluated. RESULTS: Twenty-nine intensive care units participated in the study. Surgeries were performed in 25,500 patients, of whom 904 (3.5%) were high-risk (95% confidence interval - 95%CI 3.3% - 3.8%) and were included in the study. Of the participating patients, 48.3% were from private intensive care units, and 51.7% were from public intensive care units. The length of stay in the intensive care unit was 2.0 (1.0 - 4.0) days, and the length of hospital stay was 9.5 (5.4 - 18.6) days. The complication rate was 29.9% (95%CI 26.4 - 33.7), and the 28-day postoperative mortality rate was 9.6% (95%CI 7.4 - 12.1). The independent risk factors for complications were the Simplified Acute Physiology Score 3 (SAPS 3; odds ratio - OR = 1.02; 95%CI 1.01 - 1.03) and Sequential Organ Failure Assessment Score (SOFA) on admission to the intensive care unit (OR = 1.17; 95%CI 1.09 - 1.25), surgical time (OR = 1.001, 95%CI 1.000 - 1.002) and emergency surgeries (OR = 1.93, 95%CI, 1.10 - 3.38). In addition, there were associations with 28-day mortality (OR = 1.032; 95%CI 1.011 - 1.052), SAPS 3 (OR = 1.041; 95%CI 1.107 - 1.279), SOFA (OR = 1.175, 95%CI 1.069 - 1.292) and emergency surgeries (OR = 2.509; 95%CI 1.040 - 6.051). CONCLUSION: Higher prognostic scores, elderly patients, longer surgical times and emergency surgeries were strongly associated with higher 28-day mortality and more complications during the intensive care unit stay.