Post-operative elective surgical admissions to Intensive Care Units in Australia and New Zealand
Date
2025
Authors
Emerson, Philip
Editors
Advisors
Flabouris, Arthas
Thomas, Josephine
Thomas, Josephine
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Thesis
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Abstract
An intensive care unit (ICU) is an area of a hospital that provides care for critically unwell patients. ICUs provide resource intensive care for a heterogenous group of patients and are under increasing strain. Elective surgical procedures are those that have been performed in a planned nature with the aim of optimising outcomes. 36% of admissions to ICUs in Australia and New Zealand (ANZ) occur after an elective surgical procedure, but little literature describes the case-mix, outcomes or interventions provided to this patient group. There is the possibility that we are over-utilising ICU resources in this setting, thus potentially providing limited additive care for these post operative patients, but also, diverting care away from other critically unwell patients. As a result, there is an understandable desire to improve efficiency and value from care provided in ICUs. This thesis explores the topic of post-operative ICU care for patients who have undergone an elective surgical procedure in ANZ. It comprises Five chapters, beginning with an Introduction to the research area, including a literature review. The introduction provides a broad overview of the need for research in this area, and identifies gaps in the literature, which this thesis aims to address. Chapter 2 comprises a published peer reviewed perspective piece based on the literature review, aimed at healthcare policy professionals. This piece represents a distillation of a complex and at times, heterogeneous topic. Chapter 3 is the second published peer review article, reporting on data from a prospective point prevalence study, performed in conjunction with colleagues from the George Institute of Global Health. Amongst other conclusions, this study provided data on a cohort of patients who deteriorated in a ward-based setting after their elective surgery, before requiring ICU level supports – something that has not reported in Australia previously. Chapter 4 comprises a descriptive analysis of over 300,000 patients who have undergone an elective surgical procedure before being admitted to an ICU in Australia and New Zealand. The paper is close to being submitted for consideration of publication in a peer reviewed journal. Collectively, these chapters and papers highlight the case-mix, resource utilisation, and high numbers of post-operative elective surgical patients cared for in ANZ ICUs, with their relatively low acuity of illness. The concluding Chapter 5 brings together and summarises the various papers, commenting on implications, strengths and weaknesses of the thesis and the rationale for future studies. It is hoped that this thesis may influence practice moving forward, stimulate inter-disciplinary discussions and contribute to the aggregation of marginal gains that underpins the improvements in patient outcomes in Intensive Care Medicine.
School/Discipline
Adelaide Medical School
Dissertation Note
Thesis (MClin.Sci.) -- University of Adelaide, Adelaide Medical School, 2025
Provenance
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