Elective ICU booking for postoperative patients and actual utilization

The planned postoperative utilization of the intensive care unit decreases perioperative mortality. However, the preoperative request for ICU admission is made subjectively. Some high-risk elective procedures can get delayed or cancelled due to the unavailability of the ICU bed. The American College of surgeons national surgical quality improvement (ACS NSQIP) risk calculator estimates the likelihood of postoperative complications. Thus, the increased probability of postoperative complications can guide the physician to book ICU in advance to avoid unplanned ICU admission. The primary objective was to determine the number of preoperative ICU requests generated and their utilization postoperatively after an elective surgical procedure. The secondary objective was to evaluate the characteristics of these patients using the ACS NSQIP risk calculator and its effectiveness as a predictive tool for postoperative ICU admission. Patients and methods This was a retrospective study. All patients undergoing elective non-cardiothoracic surgical procedures from January 2019 to December 2022 were included. The emergency/ urgent cases and patients with incomplete medical record were excluded. Results During the period, 940 requests were generated for postoperative ICU admission, however, only 24% (225 patients) ensued in ICU. As shown in Fig. 1, the majority of ICU requests were generated by neurosurgery (39.7%) followed by obstetrics (14.1%). Both of these specialties were accounted for least effective utilization of ICU. Most optimum utilization was ensued by the general surgery. One possible reason is the usage of the ACS NSQIP calculator is part of their practice for high-risk procedures. Cardiology consult was generated in most for anticipated high risk of major adverse cardiac events. However, as per the NSQIP calculator, 54.6% of patients had a below-average risk of cardiac complications, depicting that for majority of patients, ICU booking was overutilized. Conclusion The number of postoperative ICU bookings was higher in comparison to the actual utilization. The ACS NSQIP calculator should be considered before request generation for postoperative ICU, especially in patients with a high risk of cardiac complications. References Bainbridge D, Martin J, Arango M, Cheng D, Evidence-based Peri-operative Clinical Outcomes Research (EPiCOR) Group. Perioperative and anaesthetic-related mortality in developed and developing countries: a systematic review and meta-analysis. The Lancet. 2012 Sep 22;380(9847):1075–81.