mortalitet PREDICTORS OF TREATMENT OUTCOME OF SURGICAL PATIENTS IN THE INTENSIVE CARE UNIT: LITERATURE REVIEW
Abstract
Intensive care involves the care of life-threatening patients, i.e. care of critically ill patients who need intensive monitoring, treatment and care in order to maintain hemodynamic and respiratory balance, in order to reduce the number of complications and deaths. The aging of the population, the increased complexity of care, as well as the increasingly diverse pathology and symptomatology of certain diseases and conditions, influence the increase in the need for intensive care services in all branches of medicine, primarily in surgery. The aim of this review is to identify predictors of treatment outcomes for surgical patients in intensive care units (ICUs). Data were collected by searching several databases: PubMed, Google Scholar, Web of Science and Embase. A search was conducted for the past twenty years using the following keywords: intensive care unit, surgery, predictors, and treatment outcome. Included in our analysis were papers that analyzed the clinical outcomes of surgical patients who stayed in the ICU. It is observed that the predictors of the outcome of the treatment of surgical patients in ICU are: the severity of the patient's clinical picture before hospitalization, the type and scope of the operation, age, obesity, number of comorbidities, postoperative complications, but also the degree of organization of the health service and the competence of the health staff. Therefore, at the local, regional and global level, continuous monitoring and evaluation of predictors of treatment outcomes for surgical patients in the ICU should be developed, bearing in mind that life-threatening patients are hospitalized and that there is a high risk of complications and death. By identifying the predictors of the outcome of the treatment of surgical patients in the ICU, it will contribute to the adoption of strategies to improve the treatment of these patients.
References
Stojiljković J, Stojiljković A, Itov D. Health Care in Surgery. Belgrade: Altera Books; 2014.
Bogdanović Vasić S, Pavić K. Health Care. Šabac: ABC Design; 2022.
Victor A, Oruobu-Nwogu A. A ten-year review of the management of surgical patients in the Intensive Care Unit. WJAR. 2023;19(1): 657-666.
Ervin JN, Kahn JM, Cohen TR, Weingart LR. Teamwork in the intensive care unit. Am Psychol. 2018;73(4):468-77.
Sobol JB, Wunsch H. Triage of high-risk surgical patients for intensive care. Crit Care. 2011;15(2):217.
Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices.Evid Rep Technol Assess (Summ). 2001;1(43): i-x,1-668
Baik SM, Yang NR, Kim TY, Hong KS. Excellence of the closed intensive care unit system in critically ill surgical patients. Plos One. 2023; 18(4):e0285035
Mullan CW, Mori M, Pichert MD, Bin Mahmood SU, Yousef S, Geirsson A. United States national trends in comorbidity and outcomes of adult cardiac surgery patients. J Card Surg. 2020; 35(9):2248-53.
Leeds IL, Canner JK, Gani F, Meyers PM, Haut ER, Efron, JE, et al. Increased healthcare utilization for medical comorbidities prior to surgery improves postoperative outcomes. Ann Surg. 2020: 271(1):114-21.
The AF, Reijmerink I, Laan M, Cnossen F. Heart rate variability as a measure of mental stress in surgery: a systematic review. Int Arch Occup Environ Health. 2020(93): 805-21.
Pearse RM, Harrison DA, James P, Watson D, Hinds C, Rhodes A, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care. 2006; 10(3):R81.
Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002; 346:1128--37.
Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006; 203:865-877.
Leung JM, Dzankic S. Relative importance of preoperative health status versus intraoperative factors in predicting postoperative adverse outcomes in geriatric surgical patients. J Am Geriatr Soc. 2001; 49:1080-5.
Silva Júnior JM, Chaves RCF, Corrêa TD, Assunção MSC, Katayama HT, Bosso FE, et al. Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil. Rev Bras de TerIntensiva. 2020;321):17-27.
Onwochei DN, Fabes J, Walker D, Kumar G, Moonesinghe SR. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia. 2020; 75 (Suppl 1):e62-e74.
Majhen A. Preanaesthetic assessment of patients and premedication. Undergraduate thesis. Department of Health Studies, University of Zadar: Zadar; 2024.
Doyle DJ, Hendrix JM, Garmon EH. American Society of Anesthesiologists Classification. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK441940/
Jung M, Yang PS, Kim D, Sung JH, Jang E, Yu HT, et al. Multimorbidity in atrial fibrillation for clinical implications using the Charlson Comorbidity Index. Inter J Cardiol. 2024; 398:131605.
Palamuthusingam D, Pascoe EM, Hawley CM, Johnson DW, Fahim M. Revised cardiac risk index in predicting cardiovascular complications in patients receiving chronic kidney replacement therapy undergoing elective general surgery. Perioper Med (Lond). 2024; 13(1): 70.
Farajzadeh M, Nasrollahi E, Bahramvand Y, Mohammadkarimi V, Dalfardi B,Anushiravani A. The use of APACHE II Scoring System for predicting clinical outcome of patients admitted to the intensive care unit: a report from a resource-limited center. Shiraz E-Medical Journal. 2021; 22(5):e102858
Atance D, Claramunt MM, Varea X, Aburto JM. Convergence and divergence in mortality: A global study from 1990 to 2030. PloS One. 2024; 19(1):e0295842.
Zhu Y, Zhang R, Ye X, Liu H, Wei J. SAPS III is superior to SOFA for predicting 28-day mortality in sepsis patients based on Sepsis 3.0 criteria. Int J Infect Dis. 2024; 114:135-41.
Roepke, RML, Besen BAMP, Daltro-Oliveira R, Guazzelli RM, Bassi E, Salluh JIF, et al. Predictive Performance for Hospital Mortality of SAPS 3, SOFA, ISS, and New ISS in Critically Ill Trauma Patients: A Validation Cohort Study. J Intensive Care Med. 2024; 39(1): 44-51.
Shinohara K, Bryan TP, Bartley CE, Kelly MP, Upasani VV, Newton PO. The Utility of the Surgical Apgar Score in Assessing the Risk of Perioperative Complications Following Spinal Fusion Surgery for Pediatric Patients with Scoliosis and Cerebral Palsy. Spine (Phila Pa 1976), 2024.
Guidelines for the utilisation of intensive care units. European Society of Intensive Care Medicine. Intensive Care Med. 1994; 20(2):163-4.
Guidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine. Crit Care Med. 1999; 27(3):633-8.
Chan R, Ueno R, Afroz A, Billah B, Tiruvoipati R, Subramaniam A. Association between frailty and clinical outcomes in surgical patients admitted to intensive care units: a systematic review and meta-analysis. Br J Anaesth. 2022; 128(2):258-271.
Soni N. British Consensus Guidelines on Intravenous Fluid Therapy for Adult Surgical Patients (GIFTASUP): Cassandra's view. Anaesthesia. 2009; 64:235-8.
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360(5):491-9.
Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA. Organizational characteristics of intensive care units related to outcomes of abdominal aortic surgery. JAMA. 1999; 281(14):1310-7.
Huard P, Kalavrouziotis D, Lipes J, Simon M, Tardif MA, Blackburn S, et al. Does the full-time presence of an intensivist lead to better outcomes in the cardiac surgical intensive care unit? J Thorac Cardiovasc Surg. 2020; 159(4):1363-75.
Ali-Abadi T, Hassan B, Monir N. Critical thinking skills in intensive care and medical-surgical nurses and their explaining factors. Nurse Educ Pract. 2020; 45:102783.
Hare S, Hayden P. Role of critical care in improving outcomes for high-risk surgical patients. J Br Surg. 2020; 107(2).15-6.
Vincent JL, Sakr Y, Singer M, Martin-Loeches I, Machado FR, Marshall JC, et al. EPIC III Investigators. Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017. JAMA. 2020; 323(15):1478-1487.
Spolverato G, Capelli G, Restivo A, Bao QR, Pucciarelli S, Pawlik TM, et al. The management of surgical patients during the coronavirus disease 2019 (COVID-19) pandemic. Surgery. 2020; 168(1):4-10.