日本择期手术后非计划ICU入院的流行病学调查：一项全国性观察性研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
全球超过75%的手术为择期手术，术后非计划性ICU入院构成重大挑战，尽管这种情况较为罕见。然而，目前鲜有流行病学研究关注择期手术后直接从手术室转入ICU的非计划性患者。本研究利用日本重症监护患者数据库（JIPAD）来描述择期手术后非计划性ICU入院的情况。
方法
本研究使用2015年4月至2022年3月日本重症监护协会（JIPAD）的数据，开展了一项多中心回顾性队列研究，重点关注择期手术后非计划入住ICU的患者。收集的变量包括患者特征、治疗、结局、入住ICU的原因以及手术类型。我们将入住ICU的原因分为9类：过敏反应、出血、麻醉相关并发症、呼吸系统并发症、心血管系统并发症、神经系统并发症、手术相关并发症、电解质/酸碱平衡紊乱以及原因不明。手术类型根据JIPAD的定义进行分类。
结果
在JIPAD研究中接受择期手术的141,969例患者中，2666例（1.9%）非计划性入住ICU。其中52例（2.0%）患者在入住ICU前发生心脏骤停，APACHE III评分中位数为51分，1218例（45.7%）患者术后需要机械通气。非计划性入住ICU患者的中位住院时间为21天，院内死亡率为3.3%（88/2666）。入住ICU最常见的原因是呼吸系统并发症（n = 440，16.5%），其次是出血（n = 377，14.1%）。心血管相关并发症的院内死亡率最高，为6.8%（20/294）。医院死亡率高于ICU死亡率，这表明预期从重症监护中获益有限的患者可能已被转出ICU，以便为其他更需要的患者腾出床位。需要非计划性入住ICU的最常见手术是胃肠道肿瘤手术（n = 464，17.4%），其次是骨科手术（n = 303，11.4%）。过敏反应发生于多种手术中。呼吸系统相关并发症在患有其他呼吸系统疾病的患者中较为常见，占所有手术类型病例总数的一半以上。神经系统相关并发症在肿瘤开颅手术中最常见。
本研究回顾2015年至2022年全国ICU数据库揭示择期手术后非计划ICU入院的流行病学特征。发现非计划ICU入院率为1.9%，且死亡率因ICU入院原因而异。呼吸系统并发症最为常见，而心血管并发症与院内死亡的相关性最高。研究结果提示需针对特定手术类型优化围术期管理策略，以降低非计划ICU入院风险并改善患者预后。未来需结合术前数据进一步探索危险因素。
原始文献：Omoto M, Aoki Y, Nakajima M, et al. Epidemiological Investigation of Unplanned Intensive Care Unit Admissions From the Operating Room After Elective Surgery: A Nationwide Observational Study in Japan. Anesth Analg. 2025 Nov 1;141(5):998-1006. doi: 10.1213/ANE.0000000000007409. Epub 2025 Feb 5. PMID: 39908195.
Epidemiological Investigation of Unplanned Intensive Care Unit Admissions From the Operating Room After Elective Surgery: A Nationwide Observational Study in Japan
ABSTRACT
Background: Over 75% of surgeries worldwide are elective and unplanned ICU admissions after these surgeries pose a major-albeit rare-challenge. However, few epidemiological studies have focused on patients requiring unplanned ICU admission directly from the operating room after elective surgeries are lacking. This study uses the Japanese Intensive Care Patient Database (JIPAD) to describe unplanned ICU admissions after elective surgeries.
Methods: We conducted a multicenter retrospective cohort study using data from the JIPAD from April 2015 to March 2022, focusing on patients with unplanned ICU admissions after elective surgery. Collected variables included patient characteristics, treatments, outcomes, reasons for ICU admission, and type of surgery. We categorized the reasons for ICU admission into 9 types: anaphylaxis, hemorrhage, anesthesia-related complications, respiratory-related complications, cardiovascular-related complications, neurological-related complications, surgical-related complications, electrolyte/acid-base abnormalities, and unknown causes. The type of surgery was classified using JIPAD definitions.
Results: Among 141,969 patients in the JIPAD who underwent elective surgery, 2666 patients (1.9%) required an unplanned ICU admission. Cardiac arrest before ICU admission occurred in 52 patients (2.0%), the median APACHE III score was 51, and 1218 patients (45.7%) required postoperative mechanical ventilation. The median hospital stay for patients with unplanned ICU admission was 21 days and in-hospital mortality was 3.3% (88/2666). The most common reason for ICU admission was respiratory complications (n = 440, 16.5%), followed by hemorrhage (n = 377, 14.1%). Cardiovascular-related complications had the highest in-hospital mortality at 6.8% (20/294). Hospital mortality exceeded ICU mortality, suggesting that patients expected to derive limited benefit from intensive care may have been transitioned out of the ICU to accommodate other patients with greater need. The most frequent surgeries requiring unplanned ICU admission were for gastrointestinal neoplasms (n = 464, 17.4%), followed by orthopedic surgeries (n = 303, 11.4%). Anaphylaxis occurred across a broad spectrum of surgeries. Respiratory-related complications were common in patients with other respiratory diseases and accounted for over half of the total number of cases according to surgery type. Neurological-related complications were most frequent in craniotomies for neoplasms.
Conclusions: In our review of a nationwide ICU database from 2015 to 2022 we identified a 1.9% rate of unplanned ICU admission and found that mortality varied according to the reasons for ICU admission. Respiratory-related complications were most common, and cardiovascular complications were most associated with in-hospital mortality. Further research may help us to better understand the epidemiology of unplanned ICU admission after surgery.