Unplanned post-operative intensive care unit admissions

Phyu Phyu TIN, Anand Hanumantrao KULKARNI, Kim Hong LIM

Department of Anaesthesia, RIPAS Hospital, Brunei Darussalam

ABSTRACT

Introduction: Frequently, post-operative intensive care (Unplanned ICU Admissions, UIA) is required in an unplanned manner due to complications related to anaesthesia or surgery or underlying illnesses unmasked during procedures. There are currently no local data available on UIAs. We undertook this prospective review of UIAs to the Intensive Care Unit of the RIPAS Hospital over a period of 6 months. Materials and Methods: All UIAs between June 2011 and November 2011 were prospectively reviewed. Demographic data, underlying comorbid conditions and reasons for admission were collected and analysed. Results: Over the six month period, a total of 4,900 operations were performed, and 13 of these resulted in UIAs, giving a UIA rate of 0.27%. The mean age of patients was 48 years (range 8 to 82). Eight patients were mechanically ventilated. The reasons for admissions were: five were complications related to anaesthesia, two from massive blood loss, and six attributable to underlying illnesses. The underlying problems were cardiovascular disturbances in 46%, respiratory system disturbances in 31%, metabolic problems in 7% and massive blood loss and massive transfusion in 14%. Three patients needed intensive care only for observation and monitoring. Six patients had underlying illnesses that were unmasked or precipitated during the peri-operative period. The mean duration of ICU and hospital stay were 4.5 days (range 1-24) and 3.1 weeks (range 1-11) respectively. There were two deaths (an 8-year-old boy with craniopharyngioma and an 82-year-old lady with myocardial infarction). Conclusion: A thorough preoperative evaluation and preoperative optimisation of patients whenever possible, early recognition of complications, timely intervention and timely intensive care and monitoring are essential to improve outcomes.

Keywords: Anaesthesia, complications, operations, admission, intensive care unit

Correspondence author: Phyu Phyu TIN, Department of Anaesthesia, RIPAS Hospital, Bandar Seri Begawan BA1710, Brunei Darussalam. Tel: +673 8685848 E mail: hhpyuint@gmail.com

Brunei Int Med J. 2013; 9 (5): 302-306