Abstract:
Introduction
Intensive care is indicated for patients requiring intensive monitoring and/or organ support. It
is a costly and time limited resource utilized by those with reversible pathologies and
reasonable likelihood of survival. Patients awaiting elective surgery with preoperative intensive
care unit (ICU) bookings need to compete with emergency and unanticipated admissions
leading to cancellation and postponement of elective surgery, a disadvantage to both the
patient and the institution. Hence this study is aimed at evaluating the extent of ICU care
utilized by elective surgical patients and to analyse the indications vs. utilization of ICU care by
them.
Methods
This was a retrospective cross-sectional study carried out in the surgical ICU of Colombo South
Teaching Hospital, enrolling 47 elective surgical patients admitted to the ICU over a period of 3
months. Data was collected using a pre structured data collection form.
Results
Majority of the patients were middle aged, belonged to the American Society of
Anaesthesiologists Physical Status 2 (68.1%) and underwent colorectal (26%), upper
gastrointestinal (GI) (15%) or hepatobiliary (13%) surgeries. Main comorbidities amongst the
study population were diabetes and hypertension. Mean duration of ICU stay was 2 days. Most
patients were monitored non-invasively within the ICU (68%). Organ support was required by
only 17% of patients. Most frequent indication for preoperative ICU booking was the
surgical/anaesthetic complexity determined by British United Provident Association (BUPA)
schedule of procedures (83%). However, ICU resources were mainly utilized for provision of
analgesia particularly in the form of epidural infusions (52%).
Recommendations
We recommend the development of level 2 care/high dependency units to reduce the burden
on the ICU and a unit-based policy for ICU resource allocation for surgical patients
