Factors associated with longer stay on a surgical intensive care unit

Abstract

Introduction: The advance in medical care for surgical patients results in older patients, increasing medical problems, and complexities of operations in surgical patients. Therefore, these patients may require a longer stay in the surgical ICU (SICU). The aim of the present study was to evaluate the occurrence, clinical outcome, and predictive risk factors for the longer SICU length of stay in critically ill surgical patients in our general SICU. Methods: This study was an observation study; after the approval of the IRB, all patients admitted to the SICU from the operating theatres during the study period from 1 June to 31 December 2004 were recruited to the study. Data collection consisted of initial patient assessment and demographics, underlying problems, SICU interventions and laboratory investigations for TISS-28 and SOFA scores within the first 24 hours of ICU admission. Descriptive statistics and backward stepwise logistic regression were employed to study for independent factors associated with the longer length of SICU stay. Results: During the 6-month study period, 562 patients were admitted to the SICU with an overall mortality rate of 6.23%, and the overall average length of stay in the SICU was 2.72 days. There were 99 patients staying in the SICU longer than 4 days, with a mean of 9.12 days in these patients. The independent associated factors of SICU stay longer than 4 days were perioperative cardiac complications, odds ratio (OR) 12.77 (95% confidence interval 4.52 to 36.08); P <0.01, requirement of ventilator support, OR 6.95 (3.13 to 15.42); P <0.01, bleeding in the SICU, OR 4.85 (1.33 to 17.65); P = 0.02, perioperative respiratory complications, OR 2.77 (1.09 to 7.02); P = 0.03, emergency surgical procedures, OR 2.47 (1.35 to 4.51);P <0.01, new haemodynamic monitoring interventions in the SICU, OR 2.28 (1.28 to 4.08); P <0.01, hypotensive episodes in the SICU, OR 2.27 (1.16 to 4.45); P = 0.02, and oliguria, OR 1.82 (1.03 to 3.22); P = 0.04. Conclusions: The SICU patients who had a longer stay are associated with emergency procedures, the development of perioperative cardiac and respiratory complications, surgical bleeding, active monitoring interventions upon SICU admission, they were more likely to be hypotensive and had oliguria in the first 24 hours of the SICU stay.