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Springer, Intensive Care Medicine, 7(43), p. 971-979, 2017

DOI: 10.1007/s00134-016-4633-8

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Critical Care Admission Following Elective Surgery Was Not Associated With Survival Benefit: Prospective Analysis of Data From 27 Countries

Journal article published in 2017 by M. Chan, D. Wijeysundera, M. Wilson, M. Shulman, R. Moreno, W. Schmid, P. Wouters, S. de Hert, Á. Réa-Neto, A. Venara, K. Slim, R. M. Pearse, M. Sander, N. Pritchard, A. Rhodes and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

PURPOSE: As global initiatives increase patient access to surgical treatments, there is a need to define optimal levels of perioperative care. Our aim was to describe the relationship between the provision and use of critical care resources and postoperative mortality. METHODS: Planned analysis of data collected during an international 7-day cohort study of adults undergoing elective in-patient surgery. We used risk-adjusted mixed-effects logistic regression models to evaluate the association between admission to critical care immediately after surgery and in-hospital mortality. We evaluated hospital-level associations between mortality and critical care admission immediately after surgery, critical care admission to treat life-threatening complications, and hospital provision of critical care beds. We evaluated the effect of national income using interaction tests. RESULTS: 44,814 patients from 474 hospitals in 27 countries were available for analysis. Death was more frequent amongst patients admitted directly to critical care after surgery (critical care: 103/4317 patients [2%], standard ward: 99/39,566 patients [0.3%]; adjusted OR 3.01 [2.10-5.21]; p