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Regional variation in critical care provision and outcome after high-risk surgery

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Abstract

Purpose

Evidence of variation in mortality after surgery may indicate preventable postoperative death. We sought to determine if regional differences in outcome were present in surgical patients admitted to critical care in the UK.

Methods

We extracted data on admission characteristics, case mix and outcome of all patients admitted to UK critical care units following surgery for the calendar year of 2009. We also used publicly held data on regional population, volume of surgery and bed provision. Multilevel regression analysis was used to adjust for the effects of case mix and regional critical care bed provision on acute hospital mortality.

Results

A total of 16,147 patients admitted to critical care following surgery were included in this analysis. Median odds ratio (MOR) was used to describe regional-level variance in acute hospital mortality. Significant variation was identified (MOR 1.14; 95 % CI 1.07, 1.28) and persisted following adjustment for case mix (MOR 1.10; 95 % CI 1.04, 1.25) and regional critical care bed provision (MOR 1.09; 95 % CI 1.04, 1.24). Critical care bed utilisation (surgical critical care admissions per 100,000 surgical procedures) seemed to better explain this observation (MOR 1.03; 95 % CI 1.00, 29.26) and was associated with statistically significant reduction in mortality (OR 0.91; 95 % CI 0.85, 0.97; p = 0.01).

Conclusion

Significant regional variation in hospital mortality for patients admitted to critical care following surgery was observed. Critical care bed utilisation seemed to better explain this observation and was associated with improved outcome.

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Author information

Authors and Affiliations

  1. University of Edinburgh, Edinburgh, UK

    Michael A. Gillies, Brian Cook & Timothy S. Walsh

  2. Intensive Care National Audit and Research Centre, London, UK

    G. Sarah Power, David A. Harrison, Andrew Fleming & Kathryn M. Rowan

  3. Information Services Division, Scottish Intensive Care Society Audit Group, Edinburgh, UK

    Brian Cook

  4. Queen Mary’s University of London, London, UK

    Rupert M. Pearse

  5. Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK

    Michael A. Gillies

Authors
  1. Michael A. Gillies
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  2. G. Sarah Power
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  3. David A. Harrison
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  4. Andrew Fleming
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  5. Brian Cook
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  6. Timothy S. Walsh
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  7. Rupert M. Pearse
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  8. Kathryn M. Rowan
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Corresponding author

Correspondence to Michael A. Gillies.

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Conflicts of interest

MG holds a Chief Scientist Office (Scotland) NHS Research Scheme Fellowship. RP reports grants and personal fees from Nestle Health Sciences, personal fees from Massimo Inc., personal fees from Edwards Life Sciences, and equipment loans from LiDCO Ltd. The other authors confirm they have no conflict of interest.

Sources of funding

MG holds a research fellowship from the Chief Scientist’s Office, Scotland.

Additional information

Take-home message: Regional variation in mortality for patients admitted to ICU after high-risk surgery exists within a uniform healthcare system and persists after adjustment for case mix. Variation in absolute regional provision of intensive care beds (ICU beds per 100,000 population) did not appear to explain this finding; ICU bed utilisation (ICU admissions per 100,000 surgical procedures) better explains the observed variation and is associated with improved outcome.

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Gillies, M.A., Power, G.S., Harrison, D.A. et al. Regional variation in critical care provision and outcome after high-risk surgery. Intensive Care Med 41, 1809–1816 (2015). https://doi.org/10.1007/s00134-015-3980-1

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  • DOI: https://doi.org/10.1007/s00134-015-3980-1

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