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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

doi: 10.1097/CCM.0000000000000099
Clinical Investigations

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.

1Department of Surgery and Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.

2Department of Anesthesiology and Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD.

3Department of Clinical Effectiveness, University of Maryland Medical Center, Baltimore, MD.

4Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD.

This work was performed at the University of Maryland Medical Center and the University of Maryland School of Medicine.

Dr. Lissauer received support for travel (surgery section travel grant to present the poster of this work at the Society of Critical Care Medicine 42nd Critical Care Congress) and is employed by Shock Trauma Associates, PA, and the University of Maryland Faculty Physicians. His institution received grant support from Braun Corp. (research contract to study the effect of endotoxin removal via the BRAUN S.A.F.E. BT therapy device), Astute Medical (research contract to study the early diagnosis of acute kidney injury), and Pfizer Corp. (research contract to study apixaban in the treatment of deep vein thrombosis/pulmonary embolus). Dr. Galvagno Jr served as a board member with the American Board of Anesthesiology (Critical Care Medicine test writing committee); is employed by the University of Maryland Faculty Physicians and Shock Trauma Associates, PA; and received support for development of educational presentations from the Society of Critical Care Medicine (Airway Webinar, 2013) and United States Air Force Reserve (Reservist in United States Air Force. His institution received grant support: ECI12052 (Co-I, Ultrasonographic measures of volume responsiveness) and NCT01545232 (Pragmatic, Randomized Optimal Platelets and Plasma Ratios). Dr. Rock’s institution received support from the National Institutes of Health. Dr. Narayan is employed by the Shock Trauma Associates, PA, and the State of Maryland. Dr. Shah is employed by the Shock Trauma Associates, PA, and Faculty Physicians. Ms. Spencer is employed by the University of Maryland Medical Center. Dr. Hong is employed by the University of Maryland Anesthesiology Associates, PA, and received grant support from the American Heart Association and the United States Air Force/University of Maryland Cooperative Agreement Award. Dr. Diaz consulted for Acute Innovations, LifeCell, and Synthes and provided expert testimony for several organizations.

For information regarding this article, E-mail: mlissauer@umm.edu

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