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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study
British Journal of Anaesthesia, Volume 122, No. 1, Year 2019
Notification
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Description
Background: Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods: This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results: Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions: After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies. © 2018 British Journal of Anaesthesia
Authors & Co-Authors
Claireaux, Henry Adam
United Kingdom, Bristol
University of Bristol
Davies, Natasha Elaine Claire Garai
United Kingdom, Norwich
University of East Anglia
McNamee, Lisa
Ireland, Dublin
Royal College of Surgeons in Ireland
Hanrahan, Michael T.
Ireland, Cork
University College Cork
Sethi, Rajiv K.
United Kingdom, London
King's College London
Suresh, Sukrit
United Kingdom, London
King's College London
Patel, Mihir
United Kingdom, London
Queen Mary University of London
Mushtaq, Jameel
United Kingdom, London
St George’s, University of London
Gundogan, Buket
United Kingdom, London
University College London
Bolton, William S.
United Kingdom, Leeds
University of Leeds
Mohan, Midhun
United Kingdom, Liverpool
University of Liverpool
Burke, Joshua Richard
United Kingdom, Manchester
The University of Manchester
Morley, Rachael L.
United Kingdom, Manchester
The University of Manchester
Adams, Robert
United Kingdom, Aberdeen
University of Aberdeen
Preece, Ryan A.
United Kingdom, Cardiff
Cardiff University
Amin, Humzah
United Kingdom, Keele
Keele University
Rafiq, Nasir Muhammad
United Kingdom, Aberdeen
Aberdeen Royal Infirmary
Hayes, John D.B.
United Kingdom, Aberdeen
Aberdeen Royal Infirmary
Dynes, Katie
United Kingdom, Aberdeen
Aberdeen Royal Infirmary
Jull, Patrick
United Kingdom, Cambridge
Addenbrooke's Hospital
Hill, Arnold David Konrad
United Kingdom, Wirral
Arrowe Park Hospital
Woin, Evelina
United Kingdom, Barnet
Barnet Hospital
Ziff, Oliver
United Kingdom, Barnet
Barnet Hospital
Nixon, Gemma
United Kingdom, Belfast
Belfast City Hospital
Patel, Tapan J.
United Kingdom, Blackpool
Blackpool Victoria Hospital
Griffin, Emma J.
United Kingdom, Melrose
Borders General Hospital
Abdelgawad, Hussien Ahmed H A.
United Kingdom, Bradford
Bradford Royal Infirmary
Davies, Justine Ina
United Kingdom, Bristol
Bristol Royal Infirmary
Shafiq, Nusrat M.
United Kingdom, Bristol
Bristol Royal Infirmary
Barai, Ishani
United Kingdom, London
Charing Cross Hospital
Kim, So-hee
United Kingdom, London
Chelsea and Westminster Hospital
Attalla, Mark S.
Unknown Affiliation
Turner, Megan M.
United Kingdom, Grimsby
Diana, Princess of Wales Hospital
Wills, Jane
United Kingdom, Eastbourne
Eastbourne District General Hospital
Patel, Samir V.
United Kingdom, Redhill
East Surrey Hospital
Shepherd, Ross William
United Kingdom, Epsom
Epsom Hospital
Bassett, Jean
United Kingdom, Barrow-in-furness
Furness General Hospital
Malik, Ahmad Azam
United Kingdom, Glasgow
Gartnavel General Hospital
Sanders, Joyce Alexa
United Kingdom, Nuneaton
George Eliot Hospital
Abbas, Zaigham
United Kingdom, Birmingham
Heartlands Hospital
Keane, Pearse A.
United Kingdom, Uxbridge
Hillingdon Hospital
Jacob, Louis Ec
United Kingdom, Huddersfield
Huddersfield Royal Infirmary
Wang, Alice
United Kingdom, Great Yarmouth
James Paget University Hospital
Qamar, Mubasher A.
United Kingdom, Canterbury
Kent and Canterbury Hospital
Morgan, Catrin
United Kingdom, Ilford
King George Hospital
Pearse, Rupert M.
United Kingdom, London
King's College Hospital
Watson, Nicholas F.S.
United Kingdom, Sutton in Ashfield
King's Mill Hospital
George, Daniel J.
United Kingdom, Kingston Upon Thames
Kingston Hospital Nhs Foundation Trust
Dhar, Minakshi
United Kingdom, Leicester
Leicester Royal Infirmary
Kelly, Michael Eamon
Unknown Affiliation
Palmer, Colin Neil Alexander
Unknown Affiliation
Bell, Alan David
Unknown Affiliation
Chin, Robin
Unknown Affiliation
Koshy, Renol Mathew
United Kingdom, Wolverhampton
New Cross Hospital
Gupta, Vikas A.
United Kingdom, Wolverhampton
New Cross Hospital
Ibrahim, Ibrahim Hassan
United Kingdom, Dundee
Ninewells Hospital
Harris, Lyndsay N.
United Kingdom, Dundee
Ninewells Hospital
Mittapalli, Devender
United Kingdom, Dundee
Ninewells Hospital
Wadanamby, Shavinthi W.
United Kingdom, Sheffield
Northern General Hospital
Heywood, Emily G.
United Kingdom, Sheffield
Northern General Hospital
Toh, Cheng Hock
United Kingdom, Sheffield
Northern General Hospital
Logan, Andrew E.
United Kingdom, Harrow
Northwick Park Hospital
Wood, Alexander D.
United Kingdom, Harrow
Northwick Park Hospital
McGalliard, Rachel J.
United Kingdom, Oxford
John Radcliffe Hospital
Cundy, Olivia J.
United Kingdom, Oxford
John Radcliffe Hospital
Watson, Robyn P.
United Kingdom, Oxford
John Radcliffe Hospital
Dennis, Yoni F.
United Kingdom, Oxford
John Radcliffe Hospital
Chamberlain, MA Anne
United Kingdom, Perth
Perth Royal Infirmary
Lee, Seunghwa
United Kingdom, Perth
Perth Royal Infirmary
Qureshi, Ahmad Uzair
United Kingdom, Peterborough
North West Anglia Nhs Foundation Trust
Osman, Safinaz Hassan
United Kingdom, Portsmouth
Queen Alexandra Hospital
Heathcote, Elizabeth Jenny L.
United Kingdom, Merthyr Tydfil
Prince Charles Hospital
Jawad, Ahmed S.
United Kingdom, Birmingham
Queen Elizabeth Hospital Birmingham
Stather, Philip W.
United Kingdom, King's Lynn
Queen Elizabeth Hospital
Webb, Elizabeth Alice
United Kingdom, Romford
Queen's Hospital
McAllister, Ross
United Kingdom, Nottingham
Queen's Medical Centre
Adams, Róisín Douglas
United Kingdom, Inverness
Raigmore Hospital
Mills, Melinda C.
United Kingdom, Rotherham
Rotherham Hospital
Goh, Brian Kim Poh
United Kingdom, Blackburn
Royal Blackburn Teaching Hospital
Derbyshire, Laura F.
United Kingdom, Blackburn
Royal Blackburn Teaching Hospital
Deekonda, Praveena
United Kingdom, Exeter
Royal Devon and Exeter Hospital
Mohamud, Mohamed Farah Yusuf
United Kingdom, Newport
Royal Gwent Hospital
Singh, Ravindra Pratap
United Kingdom, Newport
Royal Gwent Hospital
Yousif, Abdallah
United Kingdom, Lancaster
Royal Lancaster Infirmary
Peters, Marjolein Josephine
United Kingdom, Lancaster
Royal Lancaster Infirmary
Horne, Laura
United Kingdom, Liverpool
Royal Liverpool University Hospital
Nicholls, Kathleen M.
United Kingdom, London
The Royal London Hospital
Venn, Mary L.
United Kingdom, London
The Royal London Hospital
Steel, Michael C.
United Kingdom, Stoke-on-trent
Royal Stoke University Hospital
Stoddart, Michael T.
United Kingdom, Bath
Royal United Hospital
Hoskins, Toby C.
United Kingdom, Newcastle
Royal Victoria Infirmary
Gardner, Evie
United Kingdom, Dudley
Russells Hall Hospital
Smith, Donna N.E.
United Kingdom, West Bromwich
Sandwell General Hospital
Kong, C. Y.
United Kingdom, Glasgow
Southern General Hospital Glasgow
Dear, Keith Brian Gordon
United Kingdom, Bristol
Southmead Hospital Bristol
Weston, Charlotte
United Kingdom, London
St George's Hospital
Ng, Li Yen
United Kingdom, London
St George's Hospital
Doherty, Colin P.
Unknown Affiliation
Dhanji, Al Rehan A.A.
United Kingdom, Leeds
St James's University Hospital
Siddiqui, Zainab H.
Unknown Affiliation
Walsh, Simon L.F.
Unknown Affiliation
Ziprin, Paul
United Kingdom, London
St Mary's Hospital
White, Christopher J.M.D.
United Kingdom, London
St Mary's Hospital
Varma, Neelam
United Kingdom, Chertsey
St. Peter’s Hospital
Heer, Rakesh S.
United Kingdom, London
St Thomas' Hospital
McGarrigle, Christine A.
Ireland, Dublin
Tallaght University Hospital
Shanahan, D.
Ireland, Dublin
Tallaght University Hospital
Bernstein, Inge Thomsen
Unknown Affiliation
McAuley, Daniel F.
United Kingdom, Ayr
University Hospital Ayr
Abdulmajid, Anouf
United Kingdom, Ayr
University Hospital Ayr
Blege, Harry K.
United Kingdom, Coventry
University Hospitals Coventry and Warwickshire Nhs Trust
Joyce, Holly L.
United Kingdom, London
University Hospital Lewisham
Robinson, Cal
United Kingdom, Manchester
Manchester University Nhs Foundation Trust
Grundy, Lisa
United Kingdom, Cardiff
University Hospital of Wales
Williams, Rebecca P.
United Kingdom, Cardiff
University Hospital of Wales
Yoganathan, Sangeetha
United Kingdom, Cardiff
University Hospital of Wales
Bhome, Rahul
United Kingdom, Southampton
University Hospital Southampton Nhs Foundation Trust
Wilson, Holly A.
United Kingdom, Southampton
University Hospital Southampton Nhs Foundation Trust
Wilson, Robert John
United Kingdom, Glasgow
Victoria Infirmary
Leslie, Kate E.
United Kingdom, Edinburgh
Western General Hospital
Sim, Dayna P.Y.
United Kingdom, Glasgow
Western Infirmary
Wells, Martin T.
United Kingdom, York
The York Hospital
McLean, Kenneth A.
Unknown Affiliation
Glasbey, James C.
Unknown Affiliation
Brooks, Thomas M.
Unknown Affiliation
Drake, Thomas M.
Unknown Affiliation
Gillies, Michael A.
Unknown Affiliation
Harrison, Ewen Munro
Unknown Affiliation
Chapman, Stephen J.
Unknown Affiliation
Khatri, Chetan
Unknown Affiliation
Bath, Michael F.
Unknown Affiliation
Kelly, Michael Denis
Unknown Affiliation
Fitzgerald, James Edward Frankland
Unknown Affiliation
Bhangu, Aneel Amir
Unknown Affiliation
Nepogodiev, Dmitri
Unknown Affiliation
Statistics
Citations: 6
Authors: 135
Affiliations: 186
Identifiers
Doi:
10.1016/j.bja.2018.07.029
ISSN:
00070912
Research Areas
Health System And Policy
Study Design
Cohort Study
Case-Control Study