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Adverse outcomes after planned surgery with anticipated intensive care admission in out-of-office-hours time periods: A multicentre cohort study

Morgan, D.J., Ho, K.M., Kolybaba, M.L. and Ong, Y.J. (2018) Adverse outcomes after planned surgery with anticipated intensive care admission in out-of-office-hours time periods: A multicentre cohort study. British Journal of Anaesthesia, 120 (6). pp. 1420-1428.

Link to Published Version: https://doi.org/10.1016/j.bja.2018.02.063
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Abstract

Background
Increasing mortality for patients admitted to hospitals during the weekend is a contentious but well described phenomenon. However, it remains uncertain whether adverse outcomes, including prolonged hospital length-of-stay (LOS), may also occur after patients undergoing major planned surgery are admitted to an intensive care unit (ICU) out-of-office-hours, either during weeknights (after 18:00) or on weekends.

Methods
All planned surgical admissions requiring admission to one of 183 ICUs across Australia and New Zealand between 2006 and 2016 were included in this retrospective population-based cohort study. Primary outcomes were hospital LOS and hospital mortality.

Results
Of the total 504 713 planned postoperative ICU admissions, 33.6% occurred during out-of-office-hours. After adjusting for available risk factors, out-of-office-hours ICU admissions were associated with a significant increase in hospital LOS [+2.6 days, 95% confidence interval (CI) 2.5–2.6], mortality [odd ratio (OR) 1.5, 95%CI 1.4–1.6], and a reduced chance of being directly discharged home (OR 0.8, 95%CI 0.8–0.8). The strongest association for adverse outcomes occurred with weekend ICU admissions (hospital LOS: +3.0 days, 95%CI 3.2–3.6; hospital mortality: OR 1.7, 95%CI 1.6–1.8). Clustering of adverse outcomes by hospitals was not observed in the generalised estimating equation analyses.

Conclusions
Despite a greater clinical staff availability and higher monitoring levels, planned surgery requiring anticipated out-of-office-hours ICU admission was associated with a prolonged hospital LOS, reduced discharge directly home, and increased mortality compared with in-office-hours admissions. Our findings have potential clinical, economic and health policy implications on how complex planned surgery should be planned and managed.

Item Type: Journal Article
Murdoch Affiliation: School of Veterinary and Life Sciences
Publisher: Oxford University Press
Copyright: © 2018 British Journal of Anaesthesia
URI: http://researchrepository.murdoch.edu.au/id/eprint/40755
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