Prospective Evaluation and Analysis of Postoperative Admissions in the Intensive Care Unit of a Tertiary Care Hospital: An Indian Update

Abstract

Introduction: The characteristics for the planned ICU admissions were not surprising. However, the reasons for unplanned ICU admission are multi-factorial and may be beyond the scope of the anaesthesiologist's role in patient care. Unplanned intensive care admission may be a useful indicator of the quality of the overall process of peri-operative care. With this background, this study was undertaken to do a prospective evaluation, analysis of post-op admissions in the Intensive Care Unit of a tertiary care hospital. Material and Methods: The present observational study was conducted in the Intensive Care Unit of a defence Tertiary Care Hospital for a period of one-year wef 1Apr 18 to 31 March 19 and all the post-operative patients were divided into two groups: Group 1 – Planned Admissions: This included those patients where surgeon and/or the anaesthesiologist had decided pre-operatively for post-op ICU admission. Group 2 – Unplanned Admissions and Emergency admission: This included those patients, whose admissions were not anticipated pre-operatively, however, due to some unexpected peri-op complications arising within 48 hours of surgery led them to ICU admission. This group also comprised of patients who were admitted after forty-eight hours of primary surgery for post-operative complications. Result: In one year, the total operated patients (excluding paediatric, cardiac) in various OTs were 18157 and out of which, 261 patients were admitted to ICU. In planned group, maximum patients were of ASA III and in unplanned/emergency admissions ASA II patients were predominant. Post-operative gastrointestinal surgery patients formed a substantial percentage of the ICU admissions in both planned (94/211; 44.55%) and unplanned admission (20/50; 40.00%). GA with endotracheal intubation was technique of anaesthesia in both planned and unplanned admission. The predominant reason for unplanned ICU admission was post-operative care and treatment following unanticipated intra-operative complications. Conclusion: Thorough pre-operative evaluation and pre-operative optimization of patients whenever possible can reduce the incidence of unplanned admission to ICU. Early recognition of complications, timely intervention and timely intensive care and monitoring are essential to improve outcomes.