Impact of postoperative intensive care unit utilization on postoperative outcomes in adults undergoing major elective noncardiac surgery

Abstract Objective There is a wide variation between hospitals with respect to rates of use of postoperative intensive care unit (ICU) after major noncardiac surgery. Whether ICU care improves patient-centered outcomes remains unknown. Days alive and out of hospital (DAH) is a novel patient-centered outcome that has been validated for surgical patients. We conducted a population-based cohort study to evaluate the association of hospital-level postoperative ICU use with DAH after select major elective noncardiac surgery. Design Historical cohort study. Setting Acute hospitals in Ontario, Canada. Patients Adults aged ≥40 years who underwent lower gastrointestinal, peripheral arterial disease and nephrectomy surgery between 2006 and 2016. Intervention The main exposure was admission to ICU within 24 h after surgery. Measurement The primary outcome was DAH at 30 days (DAH30) and secondary outcomes were DAH at 90 and 180 days (DAH90 and DAH180). Hospitals were ranked into quartiles based on the hospital-specific proportion of patients admitted to ICU within 24 h post-surgery. Descriptive statistics and hierarchical multivariable quantile regression modeling were used to assess the unadjusted and adjusted association of hospital-level ICU use with the primary and secondary outcomes for each surgical procedure. Main results The cohort included 91,950 patients. Median DAH30 was 23 days for lower gastrointestinal resection, 24 days for peripheral arterial disease and 26 days for nephrectomy. Higher hospital-specific use of ICU use after surgery was not associated with improved DAH30, DAH90 or DAH180 for any surgical group. Conclusions Hospital-specific ICU admission practice showed no association with the patient-centered outcome of DAH in select elective major noncardiac surgical procedures.