An audit of unplanned postoperative intensive care unit admissions in Enugu, Nigeria: Causes and outcome.

Abstract

ABSTRACT
OBJECTIVE: To carry out an audit of unplanned postoperative (anaesthetic and surgical) intensive care unit admissions in our hospital. This may serve as a tool to assess the perioperative management of surgical patients in our centre.

MATERIALS/METHODS: The hospital records of unbooked or unplanned post surgical/anaesthetic admissions to our intensive care from March 2003 to February 2007 were reviewed. Patients’ demographics, surgical and anaesthetic records, duration of stay in the unit, interventions and patient outcome were all noted. Obstetric theatre patients were not included in this study.

RESULTS: There were a total of 497 intensive care unit admissions with 26 unplanned intensive care unit admissions (UIA) to our intensive care unit during the 4 year span. There were 6581 anaesthetic/surgeries in the general operating theater during the study period to give an unplanned postoperative intensive care unit admission incidence of 3.9/1000 anesthetics or 0.39%. Six admissions were related to anaesthetic complications and twenty to surgical complications. The average duration of stay was 3.2 days.
There were eight deaths giving a mortality rate of 1.2/1000 anesthetics/surgeries. There were two deaths associated with anaesthetic complications while six were associated with surgical complications (post thyroidectomy; 3 fatalities) and rigid bronchoscopy (2 fatalities) and one death due to massive haemorrhage.

CONCLUSION: The majority of the admissions followed head and neck surgery and calls for involvement of experienced hands and acquisition of modern equipment in handling procedures and operations. Meticulous preoperative assessment may detect potentially difficult cases, which should be managed by the most experienced hands.