G. BUNOGERANE JURU1, J. Rickard2 1National University Of Rwanda,Surgery/General Surgery/College Of Medicine And Health Sciences,Butare, SOUTH, Rwanda 2University Of Minnesota,Minneapolis, MN, USA
Introduction:
The disease burden of surgical patients remains a global problem especially in low- and middle-income countries. This challenge extends to critically ill patients where there is a paucity of trained staff, infrastructure, resources and drugs to provide the best care to the critically ill patient. A clear understanding on the demographics, diagnosis and factors influencing the outcome of surgical intensive care unit (ICU) patients is needed to better understand critical care provided in limited resource settings. We aimed to study the disease patterns of surgical patients admitted in an ICU in a limited resource setting and determine factors influencing their outcome in order to define strategies to improve care.
Methods:
This was a cross-sectional observational study of all surgical patients admitted to the ICU of a tertiary referral hospital in Rwanda from September 2017 to March 2018. This included all patients followed by a surgical service who underwent either operative or non-operative management. We collected data on demographics, diagnosis, management and outcomes. Chi square test was used to determine factors associated with in-hospital mortality.
Results:
Over a 7-month period, there were 126 surgical patients admitted to the ICU. Most (n=86, 68%) were male with a mean age of 41 years. Many (n=56, 44%) patients had only 1 day of symptoms and presented emergently (n=105, 83%). Common indications for ICU admission included respiratory support (n=62, 49%) and postoperative recovery (n=40, 32%). The most common diagnoses were head injury (n=55, 44%), peritonitis (n=33, 26%), brain tumor (n=15, 12%) and trauma (n=13, 10%). Most (n=124, 98%) patients required mechanical ventilation while only 42 (33%) patients required vasopressors. The mean ICU length of stay was 4 days. The overall ICU mortality was 46% with the highest mortality seen in patients with peritonitis (76%). Temperature, heart rate, blood pressure, duration of symptoms, admitting team, surgical diagnosis, type of surgery (Emergency/Elective), reoperation, nutrition and vasopressors were found to be associated with an increased risk of mortality (p<0.05).
Conclusions:
Surgical patients admitted to the ICU bear a significant mortality. Common surgical ICU diagnoses include head injury and peritonitis with the highest mortality rates seen in patients with peritonitis. We recommend a review of the admission policy to optimize utility of the ICU, favoring those patients who are more likely to benefit from ICU admission. The factors found to correlate with an increased risk of mortality were fever, tachycardia and hypotension on admission, duration of symptoms, surgical diagnosis, delayed nutrition, being on vasopressors in the first hours of admission, and the length of stay.