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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2008 September;74(9):459-68
Intensive care after elective surgery: a survey on 30-day postoperative mortality and morbidity
Cavaliere F. 1, Conti G. 1, Costa R. 1, Masieri S. 2, Antonelli M. 1, Proietti R. 1
1 Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, Rome, Italy;
2 ENT Clinic, University “La Sapienza”, Rome, Italy
Background. Postoperative admission to the surgical intensive care unit (S-ICU) is routinely planned in order to prevent and treat early complications. Currently, limited studies have been conducted on this topic, and as such, early morbidity and mortality in patients undergoing postoperative intensive care were investigated.
Methods. This prospective analysis was performed in the S-ICU of a University hospital and included 1045 consecutive patients. All patients underwent elective surgery and were admitted to the S-ICU on the basis of preoperative clinical assessment. On the second, seventh, and thirtieth postoperative days, the location of the patients was recorded (ICU, surgical ward, or home) as were any complications that occurred. Predicted mortality and morbidity were assessed using the POSSUM score.
Results. The observed postoperative mortality rate was 2.4% (95% CI: 1.5-3.3%), which was much lower than the rate predicted by both POSSUM (6.2%) and P-POSSUM (5.3%) analyses, and 36% of patients experienced complications, a percentage slightly higher than that predicted by POSSUM (30.2%). The first 48 hours following surgery were characterized by the highest mortality rate (2.85 deaths per thousand vs 0.7 per thousand by the third postoperative day) as well as the highest morbidity rate (7.7% vs 4.3% between the third and seventh postoperative days, and 0.9% between the eighth and thirtieth postoperative days). The presumed causes of early death were primarily secondary to cardiovascular complications (five out of six).
Conclusions. The first 48 hours after surgery is a critical period in high-risk patients, and a stay in the S-ICU should be seriously considered. Planned admission to the S-ICU may effectively decrease postoperative mortality, as suggested by the highly significant difference between expected and observed deaths following S-ICU admission.