The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients: a cohort analysis

The medical records of all consecutive high risk surgical patients admitted to the ICU from 1996 to 1998 (open format) and from 2003 to 2005 (closed format), were reviewed. High-risk patients were defined according to the Identification of Risk in Surgical patients (IRIS) score. Parameters studied were: mortality, morbidity, ICU length of stay (LOS) and hospital LOS.Mortality of ICU patients was 25.7% in the open format group and 15.8% in the closed format group (p = 0.01). Morbidity decreased from 48.6% to 46.1% (p = 0.6). The average length of hospital stay was 17 days in the open format group, and 21 days in the closed format group (p = 0.03).High risk surgical patients in the ICU are patients that have undergone complex and often extensive surgery. These patients are in need of specialized treatment and careful monitoring for maximum safety and optimal care. Our results suggest that closed format is a more favourable setting than open format to minimize the effects of high risk surgery, and to warrant safe outcome in this patient group.Surgical patients form a relatively large portion of the patients admitted to the ICUs in the Netherlands. Approximately 58% of the patients admitted to an ICU in the Netherlands in the year 2007 underwent either urgent or elective surgery before or during ICU admission [1,2].The outcome of intensive care is determined by multiple factors. Pre-morbid condition and the severity of the presenting health problems have an important effect on outcome.The majority of postoperative complications and ICU admissions in surgical patients occur in a relative small group of high risk patients [3,4]. Various surgical risk classification systems exist that seek to identify individual patients who may develop perioperative morbidity and mortality [3-5]. For a scoring system to be useful in clinical practice it must be practical, simple to use, discriminative and rely on objective data. The Identification of Risk In Surgical patients (IRIS) score