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The Impact of Postoperative Intensive Care Unit Admission on Postoperative Hospital Length of Stay and Costs: A Prespecified Propensity-Matched Cohort Study

Thevathasan, Tharusan Cand Med*,†; Copeland, Curtis C. MD; Long, Dustin R. MD*,†; Patrocínio, Maria D. MD*,†; Friedrich, Sabine Cand Med*,†; Grabitz, Stephanie D. Cand Med*,†; Kasotakis, George MD, MPH§; Benjamin, John MD; Ladha, Karim MD, MSc; Sarge, Todd MD†,#; Eikermann, Matthias MD, PhD†,#,**

doi: 10.1213/ANE.0000000000003946
Critical Care and Resuscitation: Original Clinical Research Report

BACKGROUND: In this prespecified cohort study, we investigated the influence of postoperative admission to the intensive care unit versus surgical ward on health care utilization among patients undergoing intermediate-risk surgery.

METHODS: Of adult surgical patients who underwent general anesthesia without an absolute indication for postoperative intensive care unit admission, 3530 patients admitted postoperatively to an intensive care unit were matched to 3530 patients admitted postoperatively to a surgical ward using a propensity score based on 23 important preoperative and intraoperative predictor variables. Postoperative hospital length of stay and hospital costs were defined as primary and secondary end points, respectively.

RESULTS: Among patients with low propensity for postoperative intensive care unit admission, initial triage to an intensive care unit was associated with increased postoperative length of stay (incidence rate ratio, 1.69 [95% CI, 1.59–1.79]; P < .001) and hospital costs (incidence rate ratio, 1.92 [95% CI, 1.81–2.03]; P < .001). By contrast, postoperative intensive care unit admission of patients with high propensity was associated with decreased postoperative length of stay (incidence rate ratio, 0.90 [95% CI, 0.85–0.95]; P < .001) and costs (incidence rate ratio, 0.92 [95% CI, 0.88–0.97]; P = .001). Decisions regarding postoperative intensive care unit resource utilization were influenced by individual preferences of anesthesiologists and surgeons.

CONCLUSIONS: In patients with an unclear indication for postoperative critical care, intensive care unit admission may negatively impact postoperative hospital length of stay and costs. Postoperative discharge disposition varies substantially based on anesthesia and surgical provider preferences but should optimally be driven by an objective assessment of a patient’s status at the end of surgery.

From the *Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts

Harvard Medical School, Boston, Massachusetts

Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland

§Division of Trauma, Acute Care Surgery & Surgical Critical Care, Boston University School of Medicine, Boston, Massachusetts

Department of Anesthesia, Walter Reed National Military Medical Center, Bethesda, Maryland

Department of Anesthesia and Pain Medicine, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada

#Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

**Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany.

Published ahead of print 16 October 2018.

Accepted for publication October 16, 2018.

Funding: This study was supported by a philanthropic grant from Jeff and Judy Buzen [222,302] to author M.E. Jeff and Judy Buzen were not involved at any stage of the study.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

T. Thevathasan, C. C. Copeland, and D. R. Long contributed equally and share first authorship.

Reprints will not be available from the authors.

Address correspondence to Matthias Eikermann, MD, PhD, Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA. Address e-mail to

Copyright © 2018 International Anesthesia Research Society
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