Association between lack of intensive care unit access and mortality in acute care surgery patients at two Rwandan university teaching hospitals: A cohort study

Abstract Background: Lack of access to intensive care unit (ICU) for both surgical and non-surgical patients is common in countries with limited resources. In the current literature, there is a paucity of published data on the outcome of critically ill patients who lacked ICU access after surgery. The aim of this study was to assess the mortality and length of hospital stay for operated acute care surgery (ACS) patientswith criteria of post-operative ICU admission. Methods: This was prospective cohort study conducted on ACS patients with pre-operative criteria of ICU admission in two Rwandan university teaching hospitals. The patients were followed from admission until discharge or 30 days in-hospital. We documented basic characteristics, diagnosis, length of hospital stay and mortality. We compared mortality and length of stay in hospital for patients with timely admission, delayed admission, and patients not admitted to the ICU. Data was collected, electronically captured and analyzed using SPSS software. Results: 213 ACS patients enrolled in this study. The rate of post-operative ICU access was 38.5% (n=82) with 53 (24.9%) patients with timely ICU admission and 29 (13.6%) with delayed ICU admission. The remaining 131 (61.5%) patients were not admitted to the ICU. Mortality rate among patients with timely ICU admission was 26.4% versus 89.7% for delayed admission and 48.1% in patients with no ICU admission (p-value <0.001). The hospital-stay for timely ICU admission was 13.7 days versus 7.1 days in patients who had delayed ICU admission and 16.5 days for patients with no ICU admission (p-value <0.001). Conclusion: This study showed high mortality of ACS patients who underwent surgery with criteria to be admitted in ICU postoperatively. Increasing ICU access has the potential to improve patient outcomes.