Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000099
Clinical Investigations

Increased ICU Resource Needs for an Academic Emergency General Surgery Service*

Lissauer, Matthew E. MD, FACS1; Galvagno, Samuel M. Jr DO, PhD, MS2; Rock, Peter MD, MBA, FCCM2; Narayan, Mayur MD, MPH, MBA1; Shah, Paulesh MD1; Spencer, Heather RN, MS, MBA3; Hong, Caron MD4; Diaz, Jose J. MD, FACS, FCCM1

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Objective: ICU needs of nontrauma emergency general surgery patients are poorly described. This study was designed to compare ICU utilization of emergency general surgery patients admitted to an acute care emergency surgery service with other general surgery patients. Our hypothesis is that tertiary care emergency general surgery patients utilize more ICU resources than other general surgical patients.

Design: Retrospective database review.

Setting: Academic, tertiary care, nontrauma surgical ICU.

Patients: All patients admitted to the surgical ICU over age 18 between March 2004 and June 2012.

Interventions: None.

Measurements and Main Results: Six thousand ninety-eight patients were evaluated: 1,053 acute care emergency surgery, 1,964 general surgery, 1,491 transplant surgery, 995 facial surgery/otolaryngology, and 595 neurosurgery. Acute care emergency surgery patients had statistically significantly longer ICU lengths of stay than other groups: acute care emergency surgery (13.5 ± 17.4 d) versus general surgery (8.7 ± 12.9), transplant (7.8 ± 11.6), oral-maxillofacial surgery (5.5 ± 4.2), and neurosurgery (4.47 ± 9.8) (all p< 0.01). Ventilator usage, defined by percentage of total ICU days patients required mechanical ventilation, was significantly higher for acute care emergency surgery patients: acute care emergency surgery 73.4% versus general surgery 64.9%, transplant 63.3%, oral-maxillofacial surgery 58.4%, and neurosurgery 53.1% (all p < 0.01). Continuous renal replacement therapy usage, defined as percent of patients requiring this service, was significantly higher in acute care emergency surgery patients: acute care emergency surgery 10.8% versus general surgery 4.3%, transplant 6.6%, oral-maxillofacial surgery 0%, and neurosurgery 0.5% (all p < 0.01). Acute care emergency surgery patients were more likely interhospital transfers for tertiary care services than general surgery or transplant (24.5% vs 15.5% and 8.3% respectively, p < 0.001 for each) and more likely required emergent surgery (13.7% vs 6.7% and 3.5%, all p < 0.001). Chronic comorbidities were similar between acute care emergency surgery and general surgery, whereas transplant had fewer.

Conclusions: Emergency general surgery patients have increased ICU needs in terms of length of stay, ventilator usage, and continuous renal replacement therapy usage compared with other services, perhaps due to the higher percentage of transfers and emergent surgery required. These patients represent a distinct population. Understanding their resource needs will allow for better deployment of hospital resources.

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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