Unexpected Deaths Following Surgical Intensive Care Unit Discharge: A Six-Year Controlled Analysis

Jun Makino, John Oropello, Anthony Manasia, Roopa Kohli-Seth and Adel Bassily-Marcus

Department of Surgery, Icahn School of Medicine at Mount Sinai, USA

^*Correspondance to: Adel Bassily-Marcus 

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Abstract:

Aim: To investigate the occurrence and causes of unexpected death on non-ICU floors after surgical ICU discharge.
Methods: A retrospective chart review was conducted at an 1171-bed university hospital. All patients who were discharged alive from 14-bed SICU to non-ICU floors between January 1, 2008 and September 30, 2013 were screened for enrollment. Patients who expired on non-ICU floors (not palliative care unit or hospice) within 28 days after SICU discharge and had no documented Do Not Intubate (DNI)/ Do Not Resuscitate (DNR) orders were defined as unexpected death and included for analysis. The primary outcome was the occurrence, timing, and cause of unexpected death following SICU discharge. Next, a matched control group was selected based on primary diagnosis, age and sex. Daytime ICU discharge (7 am to 7 pm), ICU and hospital length of stay, Acute Physiology and Chronic Health Evaluation (APACHE) II score at SICU admission and SWIFT (Stability and Workload Index for Transfer) score at SICU discharge were compared between the two groups.
Results: Fourteen (0.4%) of the 3,213 discharged alive patients met the criteria of unexpected deaths. The causes of unexpected death were intra-abdominal sepsis (5/14, 36%) followed by Pulmonary Embolism (PE) (4/14, 29%), Myocardial Infarction (MI) (2/14, 14%), progressive Congestive Heart Failure (CHF) (1/14, 7%), aortic dissection (1/14, 7%) and aspiration pneumonia (1/14, 7%). While sepsis was most common (4/5, 80%) in the first seven days after SICU discharge, cardiovascular events such as PE, MI, CHF or aortic dissection were more common (7/9, 78%) thereafter. There was no difference in daytime discharge, hospital and ICU length of stay, APACHE II score or SWIFT score between the two groups.
Conclusion: The occurrence of unexpected death after SICU discharges was 14/3,213 (0.4%). The most common cause was sepsis within first seven days, and cardiovascular events thereafter. No impact of time of the ICU discharge, ICU length of stay, severity of illness or readmission risk scores on predicting ICU readmission or unexpected deaths.

Keywords:

Premature ICU discharge; Unexpected death; SICU; Daytime ICU discharge; APACHE II score; SWIFT score

Cite the Article:

Makino J, Oropello J, Manasia A, KohliSeth R, Bassily-Marcus A. Unexpected Deaths Following Surgical Intensive Care Unit Discharge: A Six-Year Controlled Analysis. World J Surg Surgical Res. 2019; 2: 1129.