Delayed admission to intensive care unit for critically surgical patients is associated with increased mortality

Background

Shortage of beds in intensive care units (ICUs) is an increasing common phenomenon worldwide. Consequently, many critically ill patients have to be cared for in other hospital areas without specialized staff, such as general wards, emergency department, post anesthesia care unit (PACU). However, boarding critically ill patients in general wards or emergency department has been associated with higher mortality. The purpose of this study was to evaluate if a delay in ICU admission, waiting in PACU and managed by anesthesiologists, affects their ICU outcomes for critically surgical patients.

Methods

A retrospective cohort of adult critically surgical patients admitted to our ICU between January 2010 and June 2012 were analyzed. ICU admission was classified as either immediate or delayed (waiting in PACU). A general estimation equation was used to examine the relationship of PACU waiting hours before ICU admission with ICU outcomes by adjusting for age, patient sex, comorbidities, surgical categories, end time of operation, operation hours, and clinical conditions.

Results

A total of 2,279 critically surgical patients were evaluated. Two thousand ninety-four (91.9%) patients were immediately admitted and 185 (8.1%) patients had delayed ICU admission. There was a significant increase in ICU mortality rates with a delay in ICU admission (P < .001). Prolonged waiting hours in PACU (≥6 hours) was associated with higher ICU mortality (adjusted odds ratio 5.32; 95% confidence interval 1.25 to 22.60, P = .024). However, longer PACU waiting times was not associated with mechanical ventilation days, ICU length of stay, and ICU cost.

Conclusion

Prolonged waiting hours in PACU because of ICU bed shortage was associated with higher ICU mortality for critically surgical patients.