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An audit of unplanned postoperative intensive care unit admissions in Enugu, Nigeria: Causes and outcome
Abstract
Objective. To carry out an audit of unplanned postoperative (anaesthetic and surgical) intensive care unit (ICU) admissions in our hospital. It was hoped that this would serve as a tool to assess the peri-operative management of surgical patients in our centre. Materials and methods. The hospital records of unbooked or unplanned post-surgical/anaesthetic admissions to our ICU from March 2003 to February 2007 were reviewed. Patient demographics, surgical and anaesthetic records, duration of stay in the unit, interventions and patient outcome were noted. Obstetric patients were not included.
Results. There were a total of 497 ICU post-surgical/anaesthetic admissions to our ICU during the 4-year study period, of which 26 were unplanned. There were 6 581 anaesthetics/operations in the general operating theatre during the study period, giving an unplanned postoperative ICU admission rate of 3.9/1 000 anaesthetics or 0.39%. Six admissions were related to anaesthetic complications and 20 to surgical complications. The average duration of stay was 3.2 days. There were 8 deaths, giving a mortality rate of 1.2/1 000 anaesthetics/operations. Of the deaths 2 were associated with anaesthetic complications and 6 with surgical complications (there were 3 deaths after thyroidectomy, 2 after rigid bronchoscopy and 1 due to massive haemorrhage). Conclusion. The majority of the admissions to the ICU followed head and neck surgery. These findings will modify practice in that more senior surgeons and anaesthetists will be involved in procedures involving the head and neck, and the necessary modern equipment will be acquired. Meticulous pre-operative assessment may detect potentially difficult cases, which should be managed by the most experienced hands.
