Background: Unplanned admission to ICU can significantly effect on perioperative morbidity, mortality and prolonged hospital stay. Also it could be contribute increased medical expenses because of concentration of medical facilities and personnel. The objective of this study was to identify the incidence and perioperative risk factors that may lead to the unplanned admission to ICU.
Materials and Methods: We reviewed the medical records of adult patients undergone an elective operation from January, 2015 to December, 2016 and been in the ICU within 24 hours. Emergency cases or surgery, which usually involves intensive care unit after surgery (cardiac, neurosurgery, etc) was excluded. Patient demographics, ASA physical status, preoperative comorbidities, type and duration of anesthesia and surgery, length of hospital and ICU stay, intraoperative adverse events, transfusion, perioperative laboratory results, mortality, social history and APACHE score were recorded. In order to identify significant independent predictors of unplanned admission to ICU, univariate and multivariate logistic regression analyses were used. For the univariate analysis, patient demographics, ASA physical status, preoperative comorbidities, type and duration of anesthesia and surgery, whether important intraoperative events occurred, transfusion and perioperative laboratory results were evaluated by chisquare or Fisher’s exact test.
Results and Discussion: The incidence of unplanned admission to ICU was 68.3% (97/142). In unplanned admission group, hospital (39.2 days) and ICU (4.8 days) stay were longer than planned admission group (33.6 and 3.3 days, respectively). Mortality was 10.3% (unplanned) and 6.7% (planned), respectively. Most common cause of admission to ICU in both group was an uncontrolled hypotension. Univariate analysis showed the unplanned admission to ICU was significantly associated with age, BMI, type of surgery, pre/postoperative hemoglobin, and duration of anesthesia/surgery, preoperative cardiac disease and history of alcohol use. Preoperative hemoglobin (OR 0.83), history of alcohol use (OR 3.22) were significant independent risk factors of the unplanned admission to ICU postoperatively.
Conclusion(s): Unplanned admission to ICU showed relatively higher mortality and prolonged hospital stay. Clinicians should be more interested in control the perioperative risk factors that affect unplanned ICU admissions.


08 / Perioperative risk factors for determining the unplanned admission to an Intensive Care Unit after surgery