POSTOPERATIVE OUTCOME OF PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT AFTER ELECTIVE AND EMERGENCY LAPAROTOMY

VALVERDE FILHO, Murilo Tavares; ARAGÃO, Gabriel Vianna Pereira; CASTRO, Igor Lima Vieira de; SANTANA, Jade de Oliveira; CODES, Liana; ZOLLINGER, Claudio Celestino; ANDRAUS, Wellington; BITTENCOURT, Paulo Lisboa

doi:10.1590/0102-67202025000010e1879

Brazil

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Original Article • ABCD, arq. bras. cir. dig. 38 • 2025 • https://doi.org/10.1590/0102-67202025000010e1879 linkcopy

POSTOPERATIVE OUTCOME OF PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT AFTER ELECTIVE AND EMERGENCY LAPAROTOMY

RESULTADOS DO PÓS-OPERATÓRIO DE PACIENTES INTERNADOS EM UNIDADE DE TERAPIA INTENSIVA APÓS LAPAROTOMIA ELETIVA E DE EMERGÊNCIA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND: Surgery is associated with a high risk for morbidity and mortality, particularly when performed in critical patients requiring intensive care unit (ICU) admission.

AIM: The aim of this study was to investigate risk factors associated with adverse outcomes in a large cohort of patients admitted to a single-center ICU after abdominal surgery.

METHODS: All patients admitted to a surgical ICU for postoperative care, from January 2016 to December 2022, were retrospectively evaluated. Data concerning demographics and clinical and perioperative variables were compared to in-hospital mortality.

RESULTS: A total of 1,717 patients (1,096 women, mean age: 61±17 years) were evaluated. Most of the patients underwent colorectal (n=499), pancreatic (n=148), biliary tract (n=147), and gastric surgeries (n=145); liver resection (n=131); and several gynecological or obstetric procedures (n=250). Only 52.3% of these surgical procedures were elective. The mean Charlson Comorbidity Index (CCI) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were 4.4±2.8 and 10.1±5.6, respectively. Mortality was observed in 158 (9.2%) patients. Age (70.4±14.3 vs. 60.6±17.1 years in survivors, p=0.002), CCI (6.1±2.5 vs. 4.3±2.8 in survivors, p=0.005), type of surgery (13.6% in emergent/urgent vs. 5.5% in elective surgeries, p<0.001), and APACHE II score (16.7±8.4 vs. 9.4±4.7 in survivors, p<0.0001) were associated with mortality on univariate analysis, but only CCI, type of surgery, and APACHE II score were independently correlated with a higher risk of death on multivariate analysis.

CONCLUSIONS: Mortality after abdominal surgery in patients requiring postoperative ICU support is less than 10% nowadays, and it is independently associated with urgent or emergent surgeries, disease severity, and comorbidity.

HEADINGS:
Morbidity; Mortality; General Surgery; Intensive Care Units

Features	n=1,717
Age (years)	61±17
Gender
Male	621 (36%)
Female	1,096 (34%)
Comorbidity
CCI (mean)	4.4±2.8
Cancer	1,069 (62%)
Type of surgery
Elective	907 (52.8%)
Urgent	788 (45.9%)
Emergent	22 (1.3%)
Wound classification
Clean	274 (16%)
Clean-contaminated	1,171 (68.2%)
Contaminated	163 (9.5%)
Dirty/infected	109 (6.3%)
Surgery duration (hours)	3.9±2.1
Outcomes
Postoperative APACHE II	10.4±5.7
ICU LOS (days)	5.7 [2-6]
Hospital LOS (days)	11.9 [4-14]
Mortality	158 (9.2%)

	Patients discharged alive (n=1,559)	Dead patients (n=158)	p-value
Age (years)	60.6±17.1	70.4±14.3	0.002
Gender			0.045
Male	552 (88.9%)	69 (11.1%)
Female	1007(91.9%)	89 (8.1%)
Comorbidity
CCI (mean)	4.3±2.8	6.1±2.5	0.005
Cancer	963 (90.1)	106 (9.9)	0.109
Type of surgery			<0.0001
Elective	857 (94.5%)	50 (5.5%)
Urgent	683 (86.7%)	105 (13.3%)
Emergency	19 (86.4%)	3 (13.6%)
Wound classification			0.001
Clean	258 (94.2%)	16 (5.8%)
Clean-contaminated	1069 (91.3%)	102 (8.7%)
Contaminated	142 (87.1%)	21 (12.9%)
Dirty/infected	90 (82.6%)	19 (17.4%)
Surgery duration (hours)	3.9±2.0	4.2±2.5	<0.0001
Outcomes
Postoperative APACHE II	9.4±4.7	16.7±8.4	<0.0001
ICU LOS (days)	5.2±6.4	10.7±12.5	<0.0001
Hospital LOS (days)	11.4±14.3	16.9±22.8	<0.0001

Variables	Univariate analysis			Multivariate analysis
Variables	OR	95%CI	p-value	OR	95%CI	p-value
Gender	1.41	1.02-1.97	0.04
Age	1.04	1.03-1.05	0.002
Type of surgery	2.63	1.85-3.74	<0.0001	2.48	1.66-3.71	<0.0001
CCI	1.24	1.17-1.32	0.005	1.16	1.07-1.26	0.004
APACHE II	1.20	1.17-1.23	<0.0001	1.18	1.15-1.22	0.0001
ICU LOS	1.063	1.05-1.08	<0.0001	1.08	1.05-1.11	0.0001
Hospital LOS	1.015	1.007-1.023	<0.0001

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[TFN1] ICU: intensive care unit; LOS: length of stay; CCI: Charlson Comorbidity Index; APACHE II: Acute Physiology and Chronic Health Evaluation II.