Abstract:
BACKGROUND. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing
postoperative critical care admission in resource-limited low- and middle-income countries.
OBJECTIVE. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical
care units in South Africa (SA).
METHODS. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all
patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All
patients admitted to critical care units during this study were included for analysis.
RESULTS. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and
111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly
higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had
septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality
was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001).
CONCLUSION. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions.
Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical
care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867).
