Research

Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study

David Lee Skinner, Kim de Vasconcellos, Robert Wise, Tonya Marianne Esterhuizen, Cate Fourie, Akhter Goolam Mahomed, P Dean Gopalan, Ivan Joubert, Hyla-Louise Kluyts, L Rudo Mathivha, Busisiwe Mrara, Jan P Pretorius, Guy Richards, Ollie Smith, Maryke Geertruida Louise Spruyt, Rupert M Pearse, Thandinkosi E Madiba, Bruce M Biccard, on behalf of the South African Surgical Outcomes Study (SASOS) investigators

Abstract


Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries.

Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA).

Methods. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis.

Results. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001).

Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867).


Authors' affiliations

David Lee Skinner, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Kim de Vasconcellos, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Robert Wise, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Tonya Marianne Esterhuizen, Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Cate Fourie, Department of Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Akhter Goolam Mahomed, Department of Critical Care, Sefako Makgatho Health Sciences University, Pretoria, South Africa

P Dean Gopalan, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Ivan Joubert, Division of Critical Care, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

Hyla-Louise Kluyts, Department of Anaesthesiology, Sefako Makgatho Health Sciences University, South Africa

L Rudo Mathivha, Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Busisiwe Mrara, Department of Anaesthesiology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa

Jan P Pretorius, Department of Critical Care, Faculty of Health Sciences, University of Pretoria, South Africa

Guy Richards, Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Ollie Smith, Department of Anaesthesia, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Maryke Geertruida Louise Spruyt, Department of Critical Care, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

Rupert M Pearse, Department of Intensive Care Medicine, Queen Mary University of London, UK

Thandinkosi E Madiba, Department of Surgery and Gastrointestinal Cancer Research Centre, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

Bruce M Biccard, Department of Anaesthesia and Perioperative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

on behalf of the South African Surgical Outcomes Study (SASOS) investigators,

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Keywords

Critical care; ICU; General surgery

Cite this article

South African Medical Journal 2017;107(5):411-419. DOI:10.7196/SAMJ.2017.v107i5.11455

Article History

Date submitted: 2017-04-25
Date published: 2017-04-25

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