Determinants of Outcome for Patients in the Medical Intensive Care Unit Requiring Abdominal Surgery

To identify objective factors, available at the time of surgical evaluation, associated with outcome for patients in the medical ICU undergoing abdominal surgery. Single-center, prospective observational study. An academic tertiary care center. The study included 1,617 consecutive patients in the medical ICU. Prospective patient surveillance and data collection. Patient demographics, severity of illness, organ system derangements, abdominal processes requiring surgery, and hospital mortality. Sixty-seven patients in the medical ICU (4.1 percent) developed an acute abdominal process potentially amenable to surgical intervention. Eleven of these patients (16.4 percent) elected not to undergo surgery (mortality=100 percent). Forty-two of the 56 patients who underwent surgery survived (75.0 percent). Stepwise logistic regression analysis identified two independent objective predictors of mortality for this patient cohort (p2 (adjusted odds ratio [AOR]=19.5; 95 percent confidence interval [CI], 7.4 to 51.5; p18 (AOR=9.4; CI=3.1 to 28.3; p=0.03). The observed mortality following surgery was stratified according to the presence or absence of these two factors: neither present, 5.1 percent; APACHE II>18 present alone, 33 percent; OSFI >2 present alone, 60 percent; and both present, 88.9 percent (p