Indications for admission and predictors of early outcomes among surgical patients admitted in the Intensive Care Unit at Bugando Medical Centre, Mwanza, Tanzania

Abstract

Background: Critically ill surgical patients have been reported to be a major cause of hospitalization and intensive care utilization worldwide and consume a significant amount of the healthcare budget. There is a paucity of published data on intensive care utilization in our environment. Therefore, we thought it was necessary to conduct this study to describe the common indications and predictors of outcomes of surgical patients admitted to the intensive care unit (ICU) in our setting and compare our results with those from other centers in the world.
Methods: This was a descriptive longitudinal study involving surgical patients admitted to the ICU from August 2017 to May 2018. Before the study commenced, ethical approval to conduct it was obtained from the relevant authority.
Results: 199 surgical patients (M: F = 1.7:1), representing 55.7% of all ICU admission, were studied. The median age of patients was 32 years. Postoperative observation/close monitoring following surgery and mechanical ventilation were the most common indications for ICU admission in 138 (69.4%) and 61 (30.7%) patients, respectively. The general surgery specialty had the highest number of patients admitted to the ICU (33.7%). The overall ICU median length of hospital stay (LOS) was 18 days. High ASA class, emergency surgery, higher APACHE score, high temperature and presence of postoperative complications were the main predictors of prolonged LOS (p <0.001). The overall ICU mortality was 39.2% and it was significantly associated with advanced age (>65 years), delayed ICU admission (>72 hours), admission systolic blood pressure < 90 mmHg, PaO2 < 90, need for ventilatory support, high admission modified APACHE II score and high serum urea levels (p < 0.001).
Conclusion: Postoperative observation/close monitoring following surgery and mechanical ventilation remain the most common indications for ICU admission at BMC. Therefore, the recovery room and the surgical high dependency unit (SHDU) of BMC should be well equipped with modern facilities for care of critically ill post-operative patients to reduce the number of ICU admissions. Factors responsible for prolonged LOS and high mortality in our patients should be addressed to be able to improve the outcome of these patients.