SOA Abstracts
Journal of the Intensive Care Society · 2025
Post-operative and critical care decisions in a single Operational Delivery Network with low numbers of enhanced and critical care bedsIntroduction: National guidelines recommend that surgical patients with a predicted 30-day mortality >1% and >5% be cared for in enhanced and critical care respectively 1 .With the current surgical demographic, and with one of the lowest provisions of enhanced and critical care beds in England 2 , it is not known what proportion of patients in the South-West fall within these risk brackets, nor where these patients are cared for postoperatively.Furthermore, it is unclear how the low critical care bed provision impacts on the decision to admit any patient referred to critical care.Objectives: To understand the number of surgical patients in the South-West with predicted mortality >1% and 5% (high risk) who are cared for in enhanced or critical care post-operatively.To assess referral and admission activity to all critical care units in the South-West and to gauge the degree to which low critical care bed provision impacts on the decision to admit.Methods: The evaluation included all 18 NHS hospitals and one non-NHS hospital in the Channel Islands, within the SWCCN operational footprint.Anonymised data of usual care was logged prospectively by anaesthetists and critical care consultants over a 7-day period between 6/11/23-13/11/23 There were 2 arms: In the peri-operative arm, every in-patient surgical episode and all procedures performed under the care of anaesthetist in the South-West was included.Cases were risk-scored retrospectively (Surgical Outcome Risk Tool, SORT) with anaesthetists blinded to the score 3 .Day-case, paediatric, obstetric and cardiac surgery were excluded.Postoperative area of care was recorded.Denominator data was obtained from each hospital's business department.In the critical care arm, anonymised data on every critical care referral and admission in the South-West were captured.Reasons for declining admission, and cancelled elective cases due to lack of critical care capacity were captured.Results: A total of 1730 peri-operative cases (78% of all activity) were captured (Table 1).SORT predicted mortality revealed 418/1730 (24.2%) were moderate risk and 250/1730 (14.5%) were high risk (Figure 1a).