Fernando Abelha*, Paula Maia*, Nuno Landeiro*, Aida Neves*, Henrique Barros†

*Departamento de Anestesiologia e Cuidados Intensivos, Hospital de São João, Porto;

†Serviço Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto

Introduction: Outcome in intensive care may be categorized as mortality or morbidity related. Mortality is an insufficient measure of Intensive Care Unit (ICU) outcome when measured alone and length of stay may be seen as an indirect measure of morbidity related outcome. Length of stay may be seen as a surrogate marker for adverse outcome and increased resource use following surgery. The aim of the present study was to evaluate case fatality rates and the determinants of death and length of stay in patients admitted to a surgical ICU.

Methods: The study was observational and prospective in a surgical ICU and all consecutive adult patients admitted between October 2004 and April 2005, who underwent noncardiac surgery, were enrolled. Patients were categorized according age, gender, body mass index, ASA physical status, type and magnitude of surgical procedure, type and duration of anesthesia, core temperature at admission, Length of stay (LOS) in the ICU and in the hospital, and mortality in the ICU and in the hospital. The Simplified Acute Physiology Score II (SAPS II) was calculated. Postoperative prolonged ICU stay was defined as intensive care lasting for seven days and longer.

Results: The mean ICU LOS was 4.22 ± 8.76 days. Significant risk factors for staying longer in ICU were SAPS II (OR 1.08; 95% CI: 1.06-1.11, p < 0.001), ASA physical status (OR 3.00; 95% CI: 1.49-6.07, p = 0.002 for ASA III/IV patients) and emergency surgery (OR 6.56; 95% CI: 1.89-12.44, p < 0.001 for emergency surgery). Forty two (11.2%) patients died during hospitalization. Mortality was significantly associated with ASA physical status (OR 3.04; 95% CI: 1.41-6.56, p = 0.005 for ASA III/IV patients), emergency surgery (OR 5.40; 95% CI: 2.74-10.64, p < 0.001), SAPS II scores (OR 1.09; 95% CI: 1.07-1.20, p < 0.001) and longer stay in ICU (OR 8.05; 95% CI: 3.95-37.18, p < 0.001).

Key-words: intensive care; outcome; postoperative period; hospital mortality; length of stay.

Determinantes da mortalidade e tempo de internamento em doentes admitidos numa Unidade de Cuidados Intensivos Cirúrgica

Introdução: Em Cuidados Intensivos (CI) os resultados podem ser avaliados de forma categorizada como relacionados com a mortalidade ou a morbilidade. Quando avaliada de forma isolada a mortalidade é uma medida insuficiente de avaliação dos resultado dos doentes críticos; o tempo de internamento na Unidade de Cuidados Intensivos (UCI) pode ser visto como uma medida indirecta do resultado relacionado com a morbilidade. O tempo de internamento pode ser visto como um marcador indirecto de resultados adversos e de maior utilização de recursos após cirurgia. O objectivo do presente estudo foi avaliar as taxas de mortalidade e os determinantes de mortalidade e tempo de internamento nos doentes admitidos numa UCI cirúrgica.

Métodos: O estudo foi observacional e prospectivo e decorreu na UCI cirúrgica do Hospital de São João, tendo sido admitidos todos os doentes, adultos, submetidos a cirurgia não cardíaca, admitidos entre Outubro de 2004 e Abril de 2005. Os doentes foram categorizados de acordo com a idade, sexo, índice de massa corporal, estado físico ASA, tipo e magnitude da cirurgia, técnica e duração da anestesia, temperatura na admissão à UCI, tempo de estadia na UCI e no hospital e mortalidade na UCI e no Hospital. Para todos os doentes foi calculado o valor do Simplified Acute Physiology Score II (SAPS II). Tempo de internamento prolongado na UCI foi considerado para os doentes com permanência de pelo menos 7 dias na UCI.

Resultados: O tempo de internamento médio na UCI foi de 4,22 ± 8,76 dias. Factores de risco significativos de tempo de internamento prolongado na UCI foram o valor do de SAPS II (OR 3,00; 95% IC: 1,49-6,07, p = 0,002 para os doentes ASA III/IV) e a cirurgia emergente (OR 6,56; 95% IC: 1,89-12,44, p < 0,001 para cirurgia emergente). Quarenta e dois (11,2%) doentes morreram durante o internamento hospitalar. A mortalidade esteve significativamente associada com o estado físico ASA (OR 3,04; 95% IC: 1,41-6,56, p = 0,005 para os doentes ASA III/IV), cirurgia de emergencia (OR 5,40; 95% IC: 2,74-10,64, p < 0,001), valores de SAPS II (OR 1,09; 95% IC: 1,07-1,20, p < 0,001) e tempo de internamento prolongado na UCI (OR 8,05; 95% IC: 3,95-37,18, p < 0,001).

Conclusões: A gravidade da doença medida avaliada pelo estado físico e índices de gravidade bem como a cirurgia de emergência foram determinantes para internamento prolongado na UCI e para maior mortalidade. Tempos de internamentos prolongados na UCI também foram determinantes de mortalidade hospitalar.

Palavras-chave: cuidados intensivos; período pós-operatório; mortalidade hospitalar; tempo de internamento.

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Correspondência:

Dr. Fernando Abelha

Hospital de São João

Alameda Prof. Hernâni Monteiro

4200-319 Porto

e-mail: abelha@mail.telepac.pt