Brazilian Journal of Anesthesiology
https://app.periodikos.com.br/journal/rba/article/doi/10.1590/S0034-70942006000100005
Brazilian Journal of Anesthesiology
Scientific Article

Mortalidade e o tempo de internação em uma unidade de terapia intensiva cirúrgica

Mortality and length of stay in a surgical intensive care unit

Fernando José Abelha; Maria Ana Castro; Nuno Miguel Landeiro; Aida Maria Neves; Cristina Costa Santos

http://dx.doi.org/10.1590/S0034-70942006000100005 Braz J Anesthesiol, vol.56, n1, p.34-45, 2006
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Resumo

JUSTIFICATIVA E OBJETIVOS: Em cuidados intensivos os resultados podem ser relacionados aos índices de mortalidade ou morbidade. Quando avaliada de forma isolada, a mortalidade é uma medida insuficiente do resultado na Unidade de Terapia Intensiva (UTI); o tempo de internação pode ser uma medida indireta do resultado relacionado com a morbidade. O objetivo do presente estudo foi avaliar a incidência e os fatores preditivos para mortalidade e tempo de internação dos pacientes admitidos numa UTI cirúrgica. MÉTODO: Participaram deste estudo prospectivo, realizado, entre abril e julho de 2004, todos os 185 pacientes submetidos a procedimentos programados ou de emergência, admitidos numa UTI cirúrgica. Foram registrados os seguintes parâmetros: idade, sexo, altura e peso, temperatura central estado físico segundo a ASA, tipo de intervenção cirúrgica, porte cirúrgico, técnica anestésica, quantidade e qualidade de fluídos administrados durante a anestesia, monitorização da temperatura ou de técnica de aquecimento corporal peri-operatório, duração da anestesia, tempo de permanência na UTI e no hospital e escore SAPS II. RESULTADOS: O tempo médio de internação na UTI foi de 4,09 ± 10,23 dias. Fatores de risco significativos para permanências mais prolongadas na UTI foram o valor do escore SAPS II, estado físico ASA, quantidade administrada, durante a intervenção cirúrgica, de colóides, unidades de plasma fresco e unidades de concentrados de hemáceas. Quatorze pacientes (7,60%) morreram durante a internação na UTI e 29 (15,70%) morreram durante a internação hospitalar. Fatores de risco independentes de mortalidade com diferença estatística significativa foram intervenções cirúrgicas de emergência, de grande porte, escores altos SAPS II, permanência prolongada na UTI e no hospital. Fatores protetores com diferença estatística significativa para risco de morte hospitalar foram baixo peso corporal e baixo índice de massa corporal (IMC). CONCLUSÕES: As internações prolongadas em UTI são mais freqüentes nos pacientes mais graves à admissão e estão associadas às maiores mortalidades hospitalares. A mortalidade hospitalar é também mais freqüente em pacientes submetidos a intervenções cirúrgicas de emergência ou de grande porte.

Palavras-chave

COMPLICAÇÕES, COMPLICAÇÕES, COMPLICAÇÕES, PÓS-OPERATÓRIO, PÓS-OPERATÓRIO, TERAPIA INTENSIVA, TERAPIA INTENSIVA

Abstract

BACKGROUND AND OBJECTIVES: Outcome in intensive care can be categorized as mortality related or morbidity related. Mortality is an insufficient measure of ICU outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. The aim of the present study was to estimate the incidence and predictive factors for intrahospitalar outcome measured by mortality and LOS in patients admitted to a surgical ICU. METHODS: In this prospective study all 185 patients, who underwent scheduled or emergency surgery admitted to a surgical ICU in a large tertiary university medical center performed during April and July 2004, were eligible to the study. The following variables were recorded: age, sex, body weight and height, core temperature (Tc), ASA physical status, emergency or scheduled surgery, magnitude of surgical procedure, anesthesia technique, amount of fluids during anesthesia, use of temperature monitoring and warming techniques, duration of the anesthesia, length of stay in ICU and in the hospital and SAPS II score. RESULTS: The mean length of stay in the ICU was 4.09 ± 10.23 days. Significant risk factors for staying longer in ICU were SAPS II, ASA physical status, amount of colloids, fresh frozen plasma units and packed erythrocytes units used during surgery. Fourteen (7.60%) patients died in ICU and 29 (15.70%) died during their hospitalization. Statistically significant independent risk factors for mortality were emergency surgery, major surgery, high SAPS II scores, longer stay in ICU and in the hospital. Statistically significant protective factors against the probability of dying in the hospital were low body weight and low BMI. CONCLUSIONS: In conclusion, prolonged ICU stay is more frequent in more severely ill patients at admission and it is associated with higher hospital mortality. Hospital mortality is also more frequent in patients submitted to emergent and major surgery.

Keywords

COMPLICATIONS, COMPLICATIONS, COMPLICATIONS, INTENSIVE CARE, INTENSIVE CARE, POSTOPERATIVE PERIOD, POSTOPERATIVE PERIOD

Referencias

Le Gall JR, Loirat P, Alperovitch A. A simplified acute physiology score for ICU patients. Crit Care Med. 1984;12:975-977.

Knaus WA, Draper EA, Wagner DP. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-829.

Knaus WA, Wagner DP, Draper EA. The APACHE III prognostic system: Risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100:1619-1636.

Castella X, Artigas A, Bion J. A comparison of severity of illness scoring systems for intensive care unit patients: results of a multicenter, multinational study. Crit Care Med. 1995;23:1327-1335.

Noseworthy TW, Konopad E, Shustack A. Cost accounting of adult intensive care: methods and human and capital inputs. Crit Care Med. 1996;24:1168-1172.

Wong DT, Gomez M, McGuire GP. Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit. Crit Care Med. 1999;27:1319-1324.

Knaus WA, Wagner DP, Zimmerman JE. Variations in mortality and length of stay in intensive care units. Ann Intern Med. 1993;118:753-761.

Ryan TA, Rady MY, Bashour CA. Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest. 1997;112:1035-1042.

Tuman KJ, McCarthy RJ, March RJ. Morbidity and duration of ICU stay after cardiac surgery: A model for preoperative risk assessment. Chest. 1992;102:36-44.

Rosenberg AL, Watts C. Patients readmitted to ICUs: a systemic review of risk factors and outcomes. Chest. 2000;118:492-502.

Hammermeister KE. Risk, predicting outcomes, and improving care. Circulation. 1995;91:899-900.

Bucerius J, Gummert JF, Walther T. Predictors of prolonged ICU stay after on-pump versus off-pump coronary artery bypass grafting. Intensive Care Med. 2004;30:88-95.

Tu JV, Jaglal SB, Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery: Steering Committee of the Provincial Adult Cardiac Care Network of Ontario. Circulation. 1995;91:677-684.

Predicting outcome in ICU patients: 2nd European Consensus Conference in Intensive Care Medicine. Intensive Care Med. 1994;20:390-397.

Gilio AE, Stape A, Pereira CR. Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study. Infect Control Hosp Epidemiol. 2000;21:340-342.

van den Berghe G, Wouters P, Weekers F. Intensive insulin therapy in the critically ill patients. N Eng J Méd. 2001;345:1359-1367.

Corwin HL, Gettinger A, Rodriguez RM. Efficacy of recombinant human erythropoietin in the critically ill patient: a randomized, double-blind, placebo-controlled trial. Crit Care Med. 1999;27:2346-2350.

Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPSII) based on a European/North American multicenter study. JAMA. 1993;270:2957-2963.

Stricker K, Rothen HU, Takala J. Resource use in the ICU: short- vs. long-term patients. Acta Anaesthesiol Scand. 2003;47:508-515.

Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281-284.

Cook TM, Day CJ. Hospital mortality after urgent and emergency laparotomy in patients aged 65 yr and over: Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth. 1998;80:776-781.

Wolters U, Wolf T, Stutzer H. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217-222.

Pedersen T, Eliasen K, Ravnborg M. Risk factors, complications and outcome in anaesthesia: A pilot study. Eur J Anaesthesiol. 1986;3:225-239.

Kongsayreepong S, Chaibundit C, Chadpaibool J. Predictor of core hypothermia and surgical intensive care unit. Anesth Analg. 2003;96:826-833.

Donati A, Ruzzi M, Adrario E. A new and feasible model for predicting operative risk. Br J Anaesth. 2004;93:393-399.

Arvidsson S, Ouchterlony J, Sjostedt L. Predicting postoperative adverse events. Clinical efficiency of four general classification systems. Acta Anaesthesiol Scand. 1996;40:783-791.

Tiret L, Hatton F, Desmonts JM. Prediction of outcome of anaesthesia in patients over 40 years: a multifactorial risk index. Stat Med. 1988;7:947-954.

Choban PS, Weireter LJ, Maynes C. Obesity and increased mortality in blunt trauma. J Trauma. 1991;31:1253-1257.

Finkielman JD, Gajic O. Afessa B - Underweight is independently associated with mortality in post-operative and non-operative patients admitted to the intensive care unit: a retrospective study. BMC Emerg Med. 2004;4.

Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest. 2003;123:1202-1207.

Garrouste-Orgeas M, Troche G, Azoulay E. Body mass index: An additional prognostic factor in ICU patients. Intensive Care Med. 2004;30:437-443.

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