The critically ill patient after hepatobiliary surgery

Background

We analyzed the causes and results of utilization of critical careservices in the special care unit in patients after surgical proceduresperformed by the hepatobiliary surgical service during a 23-month period.

Results

Thirty-two of 537 patients (6.0%) required postoperative admissionto the special care unit. Twenty-one patients were admitted directly fromoperating room or from recovery room because of inability to wean fromventilator (n = 10), hypovolemic shock (n = 4), myocardialischemia or infarction (n = 2), sepsis (n = 2), uppergastrointestinal bleeding (n = 2), and acute renal failure (n=1). Eleven postoperative patients were admitted from floor care forrespiratory failure (n = 4), cardiac dysrhythmia or infarction(n = 4), sepsis (n = 2), and upper gastrointestinal bleeding(n = 1). Thirty-eight per cent of patients (n = 12) admitted tothe special care unit after surgery died. By multivariate analysis, totalpostoperative stay in the special care unit that was greater than median totalduration of stay of 4.5 days was the only independent predictor of mortality(P = 0.041).

Conclusions

Respiratory failure was the predominant component of allcomplications after hepatobiliary surgery. No clinically useful predictors ofeventual outcome could be identified.