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Healthcare resource utilisation and predictors for critical care unit admissions after primary bariatric surgery in an Australian public hospital setting: an exploratory study using a mixed-methods approach

Xia, Q, Campbell, JA ORCID: 0000-0002-1820-6758, Si, L, Ahmad, H ORCID: 0000-0002-2580-9856, de Graaff, B ORCID: 0000-0003-0743-9561, Ratcliffe, K, Turtle, J, Marrone, J, Kuzminov, A and Palmer, AJ ORCID: 0000-0002-9703-7891 2022 , 'Healthcare resource utilisation and predictors for critical care unit admissions after primary bariatric surgery in an Australian public hospital setting: an exploratory study using a mixed-methods approach' , Australian Health Review, vol. 46, no. 1 , pp. 42-51 , doi: 10.1071/AH21251.

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Abstract

Objectives:The aim of this exploratory study was to investigate resource use and predictors associated with criticalcare unit (CCU) admission after primary bariatric surgery within the Tasmanian public healthcare system.Methods: Patients undergoing primary bariatric surgery in the Tasmanian Health Service (THS) public hospitalsystem between 7 July 2013 and 30 June 2019 were eligible for inclusion in this study. The THS provides two levels ofCCU support, an intensive care unit (ICU) and a high dependency unit (HDU). A mixed-methods approach was performedto examine the resource use and predictors associated with overall CCU admission, as well as levels of HDU and ICUadmission.Results: There were 254 patients in the study. Of these, 44 (17.3%) required 54 postoperative CCU admissions, with43% requiring HDU support and 57% requiring more resource-demanding ICU support. Overall, CCU patients were morelikely to have higher preoperative body mass index and multimorbidity and to undergo sleeve gastrectomy or gastricbypass. Patients undergoing gastric banding were more likely to require HDU rather than ICU support. Total hospital staysand median healthcare costs were higher for CCU (particularly ICU) patients than non-CCU patients.Conclusions: Bariatric surgery patients often have significant comorbidities. This study demonstrates that patientswith higher levels of morbidity are more likely to require critical care postoperatively. Because this is elective surgery,being able to identify patients who are at increased risk is important to plan either the availability of critical care or even interventions to improve patients preoperative risk. Further work is required to refine the pre-existing conditions thatcontribute most to the requirement for critical care management (particularly in the ICU setting) in the perioperativeperiod.

Item Type: Article
Authors/Creators:Xia, Q and Campbell, JA and Si, L and Ahmad, H and de Graaff, B and Ratcliffe, K and Turtle, J and Marrone, J and Kuzminov, A and Palmer, AJ
Keywords: bariatric surgery, intensive care, costs, economic evaluation, ICU, HDU, obesity
Journal or Publication Title: Australian Health Review
Publisher: C S I R O Publishing
ISSN: 0156-5788
DOI / ID Number: 10.1071/AH21251
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