Predictors of prolonged length of stay in general surgical intensive care unit

Abstract

© 2016, Medical Association of Thailand. All rights reserved. Objective: The aims of this study were to explore the incidence, clinical factors, severity scores and outcome associated with prolonged length of intensive care unit (ICU) stay >3 days. Material and Method: This study was a prospective observational study on the noncardiac surgical patients who were admitted to surgical intensive care unit in a tertiary university hospital. The cardiothoracic, neurosurgical and traumatic surgical patients or the patients who died within the first 3 days of ICU admission were excluded. Patient demographic data, preoperative predictors and severity scores (APACHE II, APACHE III, SOFA, SAPS II and MODS scores) at day 1 and day 3 of ICU admission were recorded. Results: A total of 948 patients were observed. The incidence of prolonged ICU stay was 20.1%. Patients with prolonged ICU stay had significantly higher ventilator hours (p<0.001) and ICU length of stay (p<0.001). On the multivariable analysis model of preoperative variables, the significant predictors of prolonged ICU stay were preoperative serum albumin less than 2.6 mg/dL (p = 0.023), preoperative hematocrit less than 34% (p = 0.035), emergency surgery (p = 0.003), having surgical complications (p = 0.017), having anesthetic complications (p = 0.017), admission for respiratory support with or without unstable hemodynamic (p<0.001), and sepsis on ICU admission (p = 0.003). Regarding the multivariable analysis of severity scoring system, the significant severity predictors were found only the preoperative ASA class IV (p<0.001) and emergency ASA status (p<0.001). Conclusion: About one-fifth of the study patients had prolonged ICU stay (>3 days). Low preoperative serum albumin (<2.6 mg/dL), low preoperative hematocrit (<34%), ASA physical status class IV, underwent emergency surgery, having anesthetic complications, surgical complications, sepsis on ICU admission, having respiratory support with or without unstable hemodynamic were significantly associated with prolonged ICU stay.