Epidemiological Trends of Surgical Admissions to the Intensive Care Unit in the United States

Overview

Journal J Trauma Acute Care Surg

Specialty Critical Care

Date 2020 May 9

PMID 32384370

Citations 9

Authors

Victor Vakayil

Nicholas E Ingraham

Alexandria J Robbins

Rebecca Freese

Elise F Northrop

Melissa E Brunsvold

Kathryn M Pendleton

Anthony Charles

Jeffrey G Chipman

Christopher J Tignanelli

Affiliations

Soon will be listed here.

Abstract

Background: Epidemiologic assessment of surgical admissions into intensive care units (ICUs) provides a framework to evaluate health care system efficiency and project future health care needs.

Methods: We performed a 9-year (2008-2016), retrospective, cohort analysis of all adult admissions to 88 surgical ICUs using the prospectively and manually abstracted Cerner Acute Physiology and Chronic Health Evaluation Outcomes database. We stratified patients into 13 surgical cohorts and modeled temporal trends in admission, mortality, surgical ICU length of stay (LOS), and change in functional status (FS) using generalized mixed-effects and Quasi-Poisson models to obtain risk-adjusted outcomes.

Results: We evaluated 78,053 ICU admissions and observed a significant decrease in admissions after transplant and thoracic surgery, with a concomitant increase in admissions after otolaryngological and facial reconstructive procedures (all p < 0.05). While overall risk-adjusted mortality remained stable over the study period; mortality significantly declined in orthopedic, cardiac, urologic, and neurosurgical patients (all p < 0.05). Cardiac, urologic, gastrointestinal, neurosurgical, and orthopedic admissions showed significant reductions in LOS (all p < 0.05). The overall rate of FS deterioration increased per year, suggesting ICU-related disability increased over the study period.

Conclusion: Temporal analysis demonstrates a significant change in the type of surgical patients admitted to the ICU over the last decade, with decreasing mortality and LOS in selected cohorts, but an increasing rate of FS deterioration. Improvement in ICU outcomes may highlight the success of health care advancements within certain surgical cohorts, while simultaneously identifying cohorts that may benefit from future intervention. Our findings have significant implications in health care systems planning, including resource and personnel allocation, education, and surgical training.

Level Of Evidence: Economic/decision, level IV.Epidemiologic, level IV.

Citing Articles

Patients' and family members' dyadic experience of post-operative delirium in the intensive care unit: A qualitative study.

Jing D, Weijing S, Yiyu Z Nurs Crit Care. 2025; 30(2):e13297.

PMID: 39957424 PMC: 11831243. DOI: 10.1111/nicc.13297.

The Impact of Age Differences and Injury Severity on Pedestrian Traffic Crashes: An Analysis of Clinical Characteristics and Outcomes.

Alharbi R J Clin Med. 2025; 14(3).

PMID: 39941412 PMC: 11818619. DOI: 10.3390/jcm14030741.

Using Electronic Health Records to Identify the Daily Primary Provider During Hospitalization.

Ingraham N, Shyu D, Phelan T, Mesfin N, Langworthy B, Kohn R Crit Care Explor. 2024; 6(12):e1189.

PMID: 39700341 PMC: 11661743. DOI: 10.1097/CCE.0000000000001189.

Relationship between blood urea nitrogen to serum albumin ratio and short-term mortality among patients from the surgical intensive care unit: a population-based real-world study.

Zhang J, Zhong L, Min J, Wei Y, Ding L BMC Anesthesiol. 2023; 23(1):416.

PMID: 38114922 PMC: 10729441. DOI: 10.1186/s12871-023-02384-7.

Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study.

de Bock E, Filipe M, Herman E, Pronk A, Boerma D, Heikens J Int J Surg Open. 2023; 55:100620.

PMID: 37163195 PMC: 10159662. DOI: 10.1016/j.ijso.2023.100620.

References

Damiano A, Bergner M, Draper E, Knaus W, Wagner D . Reliability of a measure of severity of illness: acute physiology of chronic health evaluation--II. J Clin Epidemiol. 1992; 45(2):93-101. DOI: 10.1016/0895-4356(92)90001-4. View

Nelson J, Cox C, Hope A, Carson S . Chronic critical illness. Am J Respir Crit Care Med. 2010; 182(4):446-54. PMC: 2937238. DOI: 10.1164/rccm.201002-0210CI. View

Wunsch H, Harrison D, Rowan K . Health services research in critical care using administrative data. J Crit Care. 2005; 20(3):264-9. DOI: 10.1016/j.jcrc.2005.08.002. View

Ward N, Chong D . Critical Care Beds and Resource Utilization: Current Trends and Controversies. Semin Respir Crit Care Med. 2015; 36(6):914-20. DOI: 10.1055/s-0035-1564876. View

Lilly C, Swami S, Liu X, Riker R, Badawi O . Five-Year Trends of Critical Care Practice and Outcomes. Chest. 2017; 152(4):723-735. DOI: 10.1016/j.chest.2017.06.050. View

Rogers W, Draper D, Kahn K, Keeler E, Rubenstein L, Kosecoff J . Quality of care before and after implementation of the DRG-based prospective payment system. A summary of effects. JAMA. 1990; 264(15):1989-94. View

Adhikari N, Fowler R, Bhagwanjee S, Rubenfeld G . Critical care and the global burden of critical illness in adults. Lancet. 2010; 376(9749):1339-46. PMC: 7136988. DOI: 10.1016/S0140-6736(10)60446-1. View

van der Sluijs A, van Slobbe-Bijlsma E, Chick S, Vroom M, Dongelmans D, Vlaar A . The impact of changes in intensive care organization on patient outcome and cost-effectiveness-a narrative review. J Intensive Care. 2017; 5:13. PMC: 5264296. DOI: 10.1186/s40560-016-0207-7. View

Martin G, Mannino D, Eaton S, Moss M . The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003; 348(16):1546-54. DOI: 10.1056/NEJMoa022139. View

10.

Kahn J, Goss C, Heagerty P, Kramer A, OBrien C, Rubenfeld G . Hospital volume and the outcomes of mechanical ventilation. N Engl J Med. 2006; 355(1):41-50. DOI: 10.1056/NEJMsa053993. View

11.

Garland A, Olafson K, Ramsey C, Yogendran M, Fransoo R . Epidemiology of critically ill patients in intensive care units: a population-based observational study. Crit Care. 2013; 17(5):R212. PMC: 4056438. DOI: 10.1186/cc13026. View

12.

Psoinos C, Flahive J, Shaw J, Li Y, Ng S, Tseng J . Contemporary trends in necrotizing soft-tissue infections in the United States. Surgery. 2013; 153(6):819-27. PMC: 3664142. DOI: 10.1016/j.surg.2012.11.026. View

13.

Wallace D, Angus D, Seymour C, Barnato A, Kahn J . Critical care bed growth in the United States. A comparison of regional and national trends. Am J Respir Crit Care Med. 2014; 191(4):410-6. PMC: 4351597. DOI: 10.1164/rccm.201409-1746OC. View

14.

Rosenberg A, Zimmerman J, Alzola C, Draper E, Knaus W . Intensive care unit length of stay: recent changes and future challenges. Crit Care Med. 2000; 28(10):3465-73. DOI: 10.1097/00003246-200010000-00016. View

15.

Sirio C, Shepardson L, Rotondi A, Cooper G, Angus D, Harper D . Community-wide assessment of intensive care outcomes using a physiologically based prognostic measure: implications for critical care delivery from Cleveland Health Quality Choice. Chest. 1999; 115(3):793-801. DOI: 10.1378/chest.115.3.793. View

16.

Knaus W, Wagner D, Draper E, Zimmerman J, Bergner M, Bastos P . The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991; 100(6):1619-36. DOI: 10.1378/chest.100.6.1619. View

17.

Qureshi A, Suri M, Nasar A, Kirmani J, Divani A, He W . Trends in hospitalization and mortality for subarachnoid hemorrhage and unruptured aneurysms in the United States. Neurosurgery. 2005; 57(1):1-8. DOI: 10.1227/01.neu.0000163081.55025.cd. View

18.

Brummel N, Balas M, Morandi A, Ferrante L, Gill T, Wesley Ely E . Understanding and reducing disability in older adults following critical illness. Crit Care Med. 2015; 43(6):1265-75. PMC: 4640688. DOI: 10.1097/CCM.0000000000000924. View

19.

Halpern N, Pastores S, Thaler H, Greenstein R . Changes in critical care beds and occupancy in the United States 1985-2000: Differences attributable to hospital size. Crit Care Med. 2006; 34(8):2105-12. DOI: 10.1097/01.CCM.0000227174.30337.3E. View

20.

Finks J, Osborne N, Birkmeyer J . Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011; 364(22):2128-37. PMC: 3150488. DOI: 10.1056/NEJMsa1010705. View