Predictors of Prolonged Length of Stay in General Surgical Intensive Care Unit
Suneerat Kongsayreepong MD*1, Naruenart Lomarat MD*1, Sarawut Thamtanavit MD*2, Chaianan Sodapak MD*3, Torpong Vongvises MD*4, Sutthima Kueaphet MD*5, Suchada Saeheng MD*6, Chulaluk Komoltri PhD*7
Affiliation : *1 Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *2 Division of Anesthesia, Chonburi Hospital, Chonburi, Thailand *3 Division of Anesthesia and Critical Care, Sunpasittiprasong Hospital, Ubonrachatanee, Thailand *4 Vipavadee Hospital, Bangkok, Thailand *5 Division of Anesthesia, Hatyai Hospital, Songkla, Thailand *6 Division of Anesthesia, Patalung Hospital, Patalung, Thailand *7 Division of Research & Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : The aims of this study were to explore the incidence, clinical factors, severity scores and outcome associated with
prolonged length of intensive care unit (ICU) stay >3 days.
Material and Method: This study was a prospective observational study on the noncardiac surgical patients who were
admitted to surgical intensive care unit in a tertiary university hospital. The cardiothoracic, neurosurgical and traumatic
surgical patients or the patients who died within the first 3 days of ICU admission were excluded. Patient demographic data,
preoperative predictors and severity scores (APACHE II, APACHE III, SOFA, SAPS II and MODS scores) at day 1 and day
3 of ICU admission were recorded.
Results : A total of 948 patients were observed. The incidence of prolonged ICU stay was 20.1%. Patients with prolonged ICU
stay had significantly higher ventilator hours (p<0.001) and ICU length of stay (p<0.001). On the multivariable analysis
model of preoperative variables, the significant predictors of prolonged ICU stay were preoperative serum albumin less than
2.6 mg/dL (p = 0.023), preoperative hematocrit less than 34% (p = 0.035), emergency surgery (p = 0.003), having surgical
complications (p = 0.017), having anesthetic complications (p = 0.017), admission for respiratory support with or without
unstable hemodynamic (p<0.001), and sepsis on ICU admission (p = 0.003). Regarding the multivariable analysis of severity
scoring system, the significant severity predictors were found only the preoperative ASA class IV (p<0.001) and emergency
ASA status (p<0.001).
Conclusion : About one-fifth of the study patients had prolonged ICU stay (>3 days). Low preoperative serum albumin (<2.6
mg/dL), low preoperative hematocrit (<34%), ASA physical status class IV, underwent emergency surgery, having anesthetic
complications, surgical complications, sepsis on ICU admission, having respiratory support with or without unstable
hemodynamic were significantly associated with prolonged ICU stay.
Keywords : Prolonged stay, Surgical intensive care unit, Predictors, Severity scores, Albumin, ASA physical status
