ACS-NSQIP criteria are associated with APACHE severity and outcomes in critically ill surgical patients.
ABSTRACT Similarity between the ICU patient data acquired by the APACHE system and the patient outcomes data acquired by the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) suggests that variables in NSQIP data could be effective mortality predictors. We theorized that identifying ACS-NSQIP preoperative data points predictive of patient outcomes would assist in identifying potential complications earlier.
Between 2006 and 2008 at the University of Maryland Medical Center, we identified 340 surgical ICU patients included in both databases as our study cohort. Median APACHE score calculation permitted division of study subjects into quartiles from which to examine length of stay, mortality variables, and ACS-NSQIP-recorded postoperative occurrences and preoperative risk factors. Outcomes were compared using each database's percentage of patients who had died.
Mortality was positively correlated with APACHE score increases. Initially, the average ICU length of stay increased, then declined. Most common postoperative occurrences were ventilator dependence >48 hours, pneumonia, unplanned intubation, sepsis, and septic shock. It was also noted that preoperative variables, such as American Society of Anesthesiologists classification and serum albumin levels, had an association with a poorer prognosis.
APACHE score predictions are consistent with ACS-NSQIP-recorded postoperative outcomes. Higher APACHE scores correlated with increased incidence of postoperative outcomes and were associated with earlier mortality in the most extremely ill. Poorer states of health before surgery also correlated with poor outcomes postoperatively.
- SourceAvailable from: Meghan B Lane-FallInternational anesthesiology clinics 01/2013; 51(4):10-21. DOI:10.1097/AIA.0b013e3182a70a52
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ABSTRACT: Acute diffuse peritonitis (ADP) is an important surgical complication associated with high morbidity and mortality; however, the risk factors associated with a poor outcome have remained controversial. This study aimed in collecting integrated data using a web-based national database system to build a risk model for mortality after surgery for ADP.Surgery Today 09/2014; DOI:10.1007/s00595-014-1026-x · 1.21 Impact Factor
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ABSTRACT: Introduction: Procalcitonin (PCT) is one of the main infl ammatory biomarkers to be evaluated in critically ill patients. Its discriminatory role among bacterial and viral etiologies, as well as in the monitoring of anti-infective treatment, is well established. The aim of this study was to evaluate whether serum PCT levels at admission to ICU were predictors of mortality in adult patients. Methods: A historical cohort study. The medical records of consecutive patients with different etiological diagnoses admitted to the General ICU of a University Hospital were assessed. The outcome (mortality) was accompanied and compared with other infl ammatory and prognostic markers. Results: The study comprised 108 patients. In patients with sepsis on admission , PCT levels were signifi cantly higher. In all groups, there was a trend to higher levels of PCT in patients who eventually died in ICU. Values above 3.0 ng/ml were predictors of mortality. Conclusions: Elevated serum PCT levels on ICU admission, besides the discriminatory aid of infection and sepsis, may be predictive of mortality.