Impact of postoperative intensive care unit utilization on postoperative outcomes in adults undergoing major elective noncardiac surgery

Objective — There is a wide variation between hospitals with respect to rates of use of postoperative intensive care unit (ICU) after major noncardiac surgery. Whether ICU care improves patient-centered outcomes remains unknown. Days alive and out of hospital (DAH) is a novel patient-centered outcome that has been validated for surgical patients. We conducted a population-based cohort study to evaluate the association of hospital-level postoperative ICU use with DAH after select major elective noncardiac surgery.

Design — Historical cohort study.

Setting — Acute hospitals in Ontario, Canada.

Patients — Adults aged ≥40 years who underwent lower gastrointestinal, peripheral arterial disease and nephrectomy surgery between 2006 and 2016.

Intervention — The main exposure was admission to ICU within 24 h after surgery.

Measurement — The primary outcome was DAH at 30 days (DAH₃₀) and secondary outcomes were DAH at 90 and 180 days (DAH₉₀ and DAH₁₈₀). Hospitals were ranked into quartiles based on the hospital-specific proportion of patients admitted to ICU within 24 h post-surgery. Descriptive statistics and hierarchical multivariable quantile regression modeling were used to assess the unadjusted and adjusted association of hospital-level ICU use with the primary and secondary outcomes for each surgical procedure.

Main Results — The cohort included 91,950 patients. Median DAH₃₀ was 23 days for lower gastrointestinal resection, 24 days for peripheral arterial disease and 26 days for nephrectomy. Higher hospital-specific use of ICU use after surgery was not associated with improved DAH₃₀, DAH₉₀ or DAH₁₈₀ for any surgical group.

Conclusions — Hospital-specific ICU admission practice showed no association with the patient-centered outcome of DAH in select elective major noncardiac surgical procedures.