The role of perioperative critical care support in a regional hospital: a prospective survey at new Somerset Hospital

Background: Postoperative critical care support is required for emergency and elective cases having either major surgery, with poor physiological states or significant comorbidities, and for support following unexpected surgical or anaesthetic complications. Research suggests that as many as 48% of all critical care unit (CCU) admissions occur postoperatively, yet limited literature is available regarding the support role that onsite critical care availability provides for surgery. Research into this area is therefore necessary to understand the impact of accessible critical care support, especially in hospitals at regional and district level. Objectives: The objective of this research is to contribute to the literature on perioperative critical care by presenting data quantifying and describing the patients requiring postoperative critical care at New Somerset Hospital (NSH) - a regional hospital in Cape Town, in the Western Province of South Africa. Further to this, the research aims to identify cases that would not have proceeded here if the option of on-site postoperative critical care did not exist. Methods: Data was collected using a prospective survey spanning a six-month period from June 2015 to November 2015. The data represented two sets of patients: 1) every case done, documenting whether they would have proceeded at NSH without the presence of a critical care unit; 2) each admission to a critical care service directly from theatre, describing their indications for admission and their postoperative critical care pathway, interventions and outcomes. Results: A total of 3247 complete cases were included in the analysis. Of the total sample of cases assessed, 66 (2%) were supported by critical care at NSH, of which roughly half (31 cases) would not have proceeded at NSH without availability of a critical care bed. Of these patients, 7 did not have a bed reserved preoperatively, and were not admitted, highlighting an important subgroup of patients: those not admitted to a CCU, but yet received surgery at NSH solely due to the potential of postoperative critical care support there. New admissions amounted to 48 (1.5%) of all cases of which 43 were emergencies, and 14 were unplanned. 45% of admissions required monitoring or epidural care only, for which High Care would have been sufficient, while 55% received cardiorespiratory support. Conclusion: These results confirm that at NSH, an on-site CCU allows for cases to proceed that would otherwise have been transferred elsewhere. Of note, obstetrics accounted for 3 of the unplanned admissions, confirming that a level 2 obstetric service requires critical care support despite treating otherwise low risk patients. This data indicates that critical care plays a beneficial role in supporting a regional theatre service. 6 Further research is required in this field to determine whether these results can be generalised to other regional hospitals. This survey should help as baseline data, especially for studies to better assess quality and outcomes against national and international metrics