Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures

Hannah Wunsch, Hayley B. Gershengorn, Colin R. Cooke, Carmen Guerra, Derek C. Angus, John W. Rowe, Guohua Li

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

BACKGROUND:: Use of intensive care after major surgical procedures and whether routinely admitting patients to intensive care units (ICUs) improve outcomes or increase costs is unknown. METHODS:: The authors examined frequency of admission to an ICU during the hospital stay for Medicare beneficiaries undergoing selected major surgical procedures: elective endovascular abdominal aortic aneurysm (AAA) repair, cystectomy, pancreaticoduodenectomy, esophagectomy, and elective open AAA repair. The authors compared hospital mortality, length of stay, and Medicare payments for patients receiving each procedure in hospitals admitting patients to the ICU less than 50% of the time (low use), 50 to 89% (moderate use), and 90% or greater (high use), adjusting for patient and hospital factors. RESULTS:: The cohort ranged from 7,878 patients in 162 hospitals for esophagectomies to 69,989 patients in 866 hospitals for endovascular AAA. Overall admission to ICU ranged from 35.6% (endovascular AAA) to 71.3% (open AAA). Admission to ICU across hospitals ranged from less than 5% to 100% of patients for each surgical procedure. There was no association between hospital use of intensive care and mortality for any of the five surgical procedures. There was a consistent association between high use of intensive care with longer length of hospital stay and higher Medicare payments only for endovascular AAA. CONCLUSIONS:: There is little consensus regarding the need for intensive care for patients undergoing major surgical procedures and no relationship between a hospital’s use of intensive care and hospital mortality. There is also no consistent relationship across surgical procedures between use of intensive care and either length of hospital stay or payments for care.

Original languageEnglish (US)
JournalAnesthesiology
DOIs
StateAccepted/In press - Jan 29 2016

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Critical Care
Medicare
Abdominal Aortic Aneurysm
Length of Stay
Intensive Care Units
Esophagectomy
Hospital Mortality
Elective Surgical Procedures
Pancreaticoduodenectomy
Cystectomy
Costs and Cost Analysis
Mortality

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Wunsch, H., Gershengorn, H. B., Cooke, C. R., Guerra, C., Angus, D. C., Rowe, J. W., & Li, G. (Accepted/In press). Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures. Anesthesiology. https://doi.org/10.1097/ALN.0000000000001024

Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures. / Wunsch, Hannah; Gershengorn, Hayley B.; Cooke, Colin R.; Guerra, Carmen; Angus, Derek C.; Rowe, John W.; Li, Guohua.

In: Anesthesiology, 29.01.2016.

Research output: Contribution to journalArticle

Wunsch, Hannah ; Gershengorn, Hayley B. ; Cooke, Colin R. ; Guerra, Carmen ; Angus, Derek C. ; Rowe, John W. ; Li, Guohua. / Use of Intensive Care Services for Medicare Beneficiaries Undergoing Major Surgical Procedures. In: Anesthesiology. 2016.
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