Abstract
Background:
Perioperative mortality remains a major global concern, especially in the high-risk surgical patient. Intensive care unit (ICU) admission is very common in the postoperative period; however, its independent effect on mortality outcomes is unclear. Additionally, the identification of important predictors of both mortality and ICU admission are critical towards optimizing perioperative care, more so in rapidly evolving healthcare systems such as the United Arab Emirates (UAE).
Objectives:
This study aimed to identify the predictors of perioperative mortality and ICU admission in high-risk surgical patients by a systematic review and meta-analysis with some contextual insights relevant to the UAE.
Methods:
A systematic review and meta-analysis were performed, including ten studies with more than 450,000 surgical patients. Eligible studies of the prospective and retrospective cohort design reporting perioperative mortality and ICU-related outcomes were eligible. Data were pooled using risk ratios (RR) with 95% confidence intervals (CI) and heterogeneity was assessed using the I2 statistic. Subgroup analyses were used to determine the influence of urgency of surgery, burden of comorbidity, postoperative complications, and ICU utilization.
Results:
This pooled analysis showed a significantly higher risk of mortality in the high-risk and emergency surgical populations, and the overall risk ratio was 1.38 (95% CI: 1.24-1.53; I2 = 67%). Emergency surgery was a significant predictor of mortality (RR = 2.21; 95% CI: 1.85-2.64; I2 = 59%) and a higher comorbidity burden was also a significant predictor of increased risk of mortality (RR = 1.72; 95% CI: 1.48-2.01; I2 = 52%). Postoperative complications were Postoperative complications were strongly associated with mortality (RR = 2.84; 95% CI: 2.30 - 3.51; I² = 61%). There was no significant difference in mortality with ICU admission (RR = 0.96; 95% CI: 0.88-1.05; I2 = 41%), but more patients in emergency surgery and with a greater burden of comorbidities used ICU. The rates of deaths were lower than 1% in elective operations and more than 5 percent in emergency cases. The differences in the use of different healthcare facilities and the outcomes of ICU utilization indicates a significant need to consider such factors when designing perioperative care systems, including those in the UAE.
Conclusion:
Surgical urgency, the burden of comorbidities and postoperative complications are the leading factors in perioperative mortality in high-risk surgical patients, whereas ICU admission alone is not a factor that contributes to better survival outcomes. These findings highlight the importance of specific risk stratification and optimal ICU resource utilization, especially in rapidly developing healthcare systems such as the UAE.