Predictors of Mortality and Outcomes of Ventilated Patients Managed in a Resource-Limited Acute Surgical Ward

Abstract

Background: Acute care surgery is an important component of health care in the developed nations. However, in Malaysia, acute care surgery is yet to be recognized as a specific subspecialty service. Due to high demands of limited ICU beds, some patients have to be ventilated in the wards. This study aims to describe the outcomes of acute surgical patients that required mechanical ventilation. Methods: This is a retrospective review of all mechanically ventilated surgical patients in the wards, in a tertiary hospital, in 2020. Sixty-two patients out of 116 patients ventilated in surgical wards fulfilled the inclusion criteria. Demography, surgical diagnosis and procedures and physiologic, biochemical and survival data were analyzed to explore the outcomes and predictors of mortality. Results: Twenty-two out of 62 patients eventually gained ICU admission. Mean time from intubation to ICU entry and mean length of ICU stay were 48 h (0 to 312) and 10 days (1 to 33), respectively. Survival for patients admitted to ICU compared to ventilation in the acute surgery wards was 54.5% (12/22) vs 17.5% (7/40). Thirty-four patients underwent surgery, and the majority were bowel-related emergency operations. SAPS2 score validation revealed AUC of 0.701. More than half of patients with mortality risk < 50% eventually were not admitted to ICU. Conclusions: ICU care for critically ill surgical patients provides better survival. There is a need to improve triaging for intensive care, especially for low-mortality-risk patients using risk scores which are locally validated.