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Minerva Anestesiologica 2020 Dec 10

DOI: 10.23736/S0375-9393.20.14374-8


lingua: Inglese

Changes in the incidence and outcome of multiple organ failure in emergency non-cardiac surgical admissions: a 10-year retrospective observational study

Miia M. JANSSON 1 , Pasi OHTONEN 2 , Hannu SYRJÄLÄ 3, Tero ALA-KOKKO 4

1 Research Group of Medical Imaging, Physics and Technology, Oulu University Hospital, University of Oulu, Oulu, Finland; 2 Division of Operative care, Oulu University Hospital, Medical Research Center Oulu, University of Oulu, Oulu, Finland; 3 Department of Infection Control, Oulu University Hospital, Oulu, Finland; 4 Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland


BACKGROUND: During the past decades, epidemiologic data of independent predictors of multiple organ failure (MOF), incidence, and mortality have changed. The aim of the study was to assess the potential changes in the incidence and outcomes of MOF during one decade (2008-2017) . In addition, resource utilization was taken into account.
METHODS: Patients were eligible for inclusion if they were adults, admitted to the ICU between January 1, 2008 and December 31, 2017, and had complete data sets regarding MOF. MOF was defined as organ failure separately with and without central nervous system (CNS) failure. The onset of MOF was defined as being early (≤48 h of ICU admission) and late (>48 h after ICU admission).
RESULTS: Of a total of 13,270 patients enclosed in this study, 44.6% of the patients developed MOF with and 31.4% without CNS failure. MOF-related mortality decreased in patients with (adjusted IRR 0.972 [95% CI 0.948 to 0.996], p =0.022) and without (adjusted IRR 0.957 [95% CI 0.931 to 0.983], p =0.0013) CNS failure. In addition, the incidence (adjusted IRR 0.970 [95% CI 0.950 to 0.991], p =0.006) and mortality (adjusted IRR 0.968 [95% CI 0.940 to 0.996], p =0.025) of early-onset MOF decreased, while the incidence and mortality of late-onset MOF remained constant. The length of ICU (p =0.024) and hospital (p =0.032) stays decreased while the length of mechanical ventilation remained constant (p =0.41).
CONCLUSIONS: Despite all improvements in intensive care during the last decades, the incidence of lateonset MOF remains a resource-intensive, morbid, and lethal condition. More research on etiologies, signs of organ failure, and where and when to start treatment is needed to improve the prognosis of late-onset MOF.

KEY WORDS: Epidemiology; Mortality; Multiple organ failure

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