Indications for Postoperative Admission
Session Overview
Description
This session explores the rationale for critical care admission in the postoperative patient, how to identify patients likely to benefit from critical care and the benefits of admission.

Session Introduction

By the end of this session you will be able to:

• Explain the rationale for postoperative critical care admission
• Describe how you would identify the high-risk operative patient
• List ways in which high-risk patients may benefit from critical care admission
• Describe how admission to critical care might impact upon enhanced recovery programmes

One of the main functions of critical care is the provision of postoperative care for the high-risk surgical patient. Patients are frequently admitted to critical care in the immediate postoperative period for close observation, facilitating the reversal of abnormal perioperative physiology, identification of immediate complications and possible attenuation of the stress response to surgery.

Postoperative critical care admission encompasses everything from level two care in specialized postoperative surgical care units, where nursing levels are higher than a standard ward, so that patients can be monitored, through to admission to a level three intensive care bed for organ system support, e.g. continued ventilation, haemodynamic support and renal replacement therapies.

Intensive Care National Audit and Research Centre (ICNARC) data published in 2004 showed that nearly 26% of critical care admissions were after elective or scheduled surgery [1]. Add to this the number admitted from emergency surgery, which have not been quantified by ICNARC, and it becomes clear that postoperative admissions account for a significant proportion of critical care workload.

Given that critical care is an expensive limited resource it is necessary to evaluate and understand the rationale behind postoperative admissions.