Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study

  • D.L. Skinner
  • K de Vasconcellos
  • R Wise
  • T.M. Esterhuizen
  • C Fourie
  • A Goolam Mahomed
  • P.D. Gopalan
  • I Joubert
  • H Kluyts
  • L.R. Mathivha
  • B Mrara
  • J.P. Pretorius
  • G Richards
  • O Smith
  • M.G.L. Spruyt
  • R.M. Pearse
  • T.E. Madiba
  • B.M. Biccard

Abstract

Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries.

Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA).

Methods. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis.

Results. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001).

Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867).

Published
2017-05-05
Section
Articles

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eISSN: 0256-95749
print ISSN: 2078-5135