Dados do Trabalho

Título

Trends in perioperative practices of high-risk surgical patients over a 10-year interval

Objetivo

In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two multicenter cohort studies.

Métodos

The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards.

Resultados

704 patients were analyzed. Comparatively, 2008 cohort had more postoperative infections (OR=13.4; 95% CI 6.1–29.3) and cardiovascular complications (OR=1.5; 95% CI 1.0–2.2), as well as a lower survival ICU stay (HR=2.39, 95% CI: 1.36-4.20) and hospital stay (HR=1.64, 95% CI 1.03-2.62). In addition, it was found that the risk of death correlated with higher intraoperative fluid balance (OR=1.03, 95% CI 1.01-1.06), higher creatinine (OR=1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR=2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43mmHg to 118mmHg, the risk of death decreased (OR=0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery.

Conclusão

In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.