Critical care admission of South African (SA) surgical patients : results of the SA surgical outcomes study

Skinner, David Lee ; De Vasconcellos, Kim ; Wise, Robert ; Esterhuizen, Tonya Marianne ; Fourie, Cate ; Mahomed, Akhter Goolam ; Gopalan, P. Dean ; Joubert, Ivan ; Kluyts, Hyla-Louise ; Mathivha, L. Rudo ; Mrara, Busisiwe ; Pretorius, Jan P. ; Richards, Guy ; Smith, Ollie ; Spruy, Maryke Geertruida Louise ; Pearse, Rupert M. ; Madiba, Thandinkosi E. ; Biccard, Bruce M. (2017)

CITATION: Skinner, D. L., et al. 2017. Critical care admission of South African (SA) surgical patients : results of the SA surgical outcomes Study. South African Medical Journal, 107(5):411-419, doi:10.7196/SAMJ.2017.v107i5.11455.

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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 (NCT02141867).

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