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Identifier 000417292
Title Συσχέτιση περιεγχειρητικών κριτηρίων εισαγωγής στη ΜΕΘ με μετεγχειρητική νοσηρότητα κ θνητότητα
Alternative Title Correlation between perioperative criteria for admission to ICU and postoperative morbidity and mortality
Author Συρογιάννη Παυλίνα Αθανασία
Thesis advisor Κονδύλη, Ευμορφία
Reviewer Μπριασούλης, Γεώργιος
Αγγουριδάκης, Παναγιώτης
Abstract Background Today's estimates show that 310 million patients are undergoing surgery worldwide every year. Post-operative complications are an important factor in morbidity and mortality. In developed countries, estimates suggest that postoperative complications may occur in up to 20% of patients and short-term mortality may range from 1% to 4%. The criteria and the value of regular admission of post-operative high-risk patients to an Intensive Care Unit after surgery are highly controversial and questionable. Unfortunately, current guidelines and studies are not targeting the surgical population. The International Surgical Study of Outcomes (ISOS) showed that from the 9.7% of patients who admitted to ICU immediately after elective surgery, 50.4% developed a complication with a mortality rate of 2.4%. Recently, the value of routinely administered ICU after elective surgery has been questioned given the cost and the lack of reliable data in favor of it. In addition, the categorization of high-risk patients, who may benefit from post-operative ICU admission, remains a major challenge that leads to inequality in resource distribution. Pre-operative clinical status of the patient is one of the factors that significantly influence the outcome during the perioperative period. Many scoring systems have been used to assess the patient's clinical condition and make further decisions on perioperative management. A post-operative "interim" treatment is proposed which will represent a sufficiently safe environment for the majority of surgical patients, with a significant cost reduction as well as the avoidance of complications associated with hospitalization in the ICU. Objectives This study concerns a retrospective study of patients who were admitted to the ICU for adults of University Hospital of Heraklion directly after elective non-cardiac surgery during the period; 1/1/2016 to 31/12/2016. The study was based on prognostic factors for postoperative effects, which can be divided into three categories: preoperative, intraoperative and postoperative. Comorbitities, patient scoring systems, intraoperative data, and variables in ICUs were recorded. Results In the present study, 22.4% of the patients of ICU of University Hospital of Heraklion were found to be post-operative patients after elective surgery. Age appears to have a statistically significant difference in patients undergoing high-risk surgeries (p <0.001), in patients with ASA&ge;3 and CCI&ge;5, and at the combination of these two scores. A statistically significant difference between the 2 groups of patients undergoing high risk surgery compared to those who underwent average risk surgery was observed in ASA score and CCI. Significant statistical difference (p <0.001) was also found among the survivors and non-survivors of the following: the ICU stay time, the duration of mechanical ventilation and the duration of vasoactive drugs. Mortality in ICU was estimated at 7%. Age, ASA score, CCI, severity and duration of surgery in this study cannot be used as predictors of survival in ICU of postoperative patients. Conclusions Patients undergoing elective surgical procedures and are admitted post-operatively to the ICU of University Hospital of Heraklion are more than the patients in ISOS. Mortality rate is 7% compared to 2.4% in ISOS. No particular correlation of pre- and intraoperative criteria with morbidity and mortality was found. As stated in the literature, further studies are needed to establish clear criteria for post-operative admission to the ICU. As well as the benefits of postoperative introduction to ICU are questionable, the creation of a surgical High Dependency Unit is likely to provide more significant benefits to these patients.
Language Greek
Subject Survival
Issue date 2018-07-18
Collection   Faculty/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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