[Comparative analysis of patients admitted to Spanish Intensive Care Units due to medical and surgical disease]

Abstract

Objective: To describe the characteristics of the patients case-mix admitted to ICUs due to medical and surgical disease, and to compare both groups.

Design: Analysis of data covering the period 2006-2011 in the ENVIN-HELICS registry. An observational, prospective, multicenter and voluntary participation study.

Setting: A total of 188 Spanish ICUs.

Patients: All patients admitted for more than 24 hours.

Main variables: Demographic data, cause of admission, severity scores, length of stay, mortality.

Results: A total of 138,999 patients were analyzed. Of these, 65,467 (47.1%) were admitted due to a non-coronary medical cause, 27,785 (20,0%) due to coronary-related illness, 28,044 (20,2%) after elective surgery and 17,613 (12.7%) after urgent surgery. Use of devices, nosocomial infections and isolation of multirresistant organisms were more prevalent in urgent surgery patients. Longer length of stay (median 5 days; interquartile range 2-11) as well as higher severity scale values (APACHE II and SAPS II) corresponded to this same group of patients. Mortality was higher in non-coronay medical patients. On categorizing the patients according to the APACHE II score, mortality was seen to be higher in urgent surgery cases than in elective surgery patients in all groups. The largest difference was observed in the APACHE II score 6-10 group (3% vs. 0.9%) (OR: 2.14, 95% CI 1.825-2.513; p<0.001).

Conclusions: The mortality rate is higher in non-coronary medical patients, though resource use per patient is greater in the urgent surgery cases. The APACHE II scale underestimates mortality in emergency surgery patients.

Keywords: APACHE II; Case-mix; Cuidados intensivos; Elective surgery; Intensive care; Medical disease; Mortalidad; Mortality; Pacientes médicos; Quirúrgico programado; Quirúrgico urgente; Urgent surgery.