P2.N276: Identifying Risk Factors for Unplanned Intensive Care Unit Admission in Post-Operative Patients at a Large Pediatric Institution; a Retrospective Review

Purpose/Objectives: Due to the high medical complexity of many of the patients seen in quaternary care Children’s hospitals, institutions have introduced surgical hospital co-management (SCM) teams. We recently implemented a SCM known specifically as the Surgical Hospital Assisted Recovery Team (SHARe Team) at our quaternary care children’s hospital with the goal of decreasing post-operative complications. Prior to this investigation, we used an institution specific variable known as the “complexity score” (a number from 1 to 4 that is generated automatically from the patient’s electronic health record) and gestalt to determine if patients with a known surgical diagnosis should be preemptively admitted to the SHARe team. This study assessing risks for unplanned intensive care unit (ICU) admissions, combined with a study assessing risks for unplanned re-admissions, is the initial step for our over-arching goal to create a validated and universally accepted scoring system for admitting patients to a surgical co-management team. The aim of this retrospective review is to identify risk factors for unplanned ICU admissions among post-operative patients at a large quaternary pediatric institution.

Design/Methods: We conducted a retrospective review of all patients who experienced an unplanned ICU admission post-operatively at our institution between 2019-2021. Data collected included patient demographics, medical and surgical history, clinical course details and reason for unplanned ICU admission. We used descriptive statistics to identify potential factors that may increase the risk for an unplanned ICU admission and therefore could derive benefit from SHARe Team admission.

Results: A total of 25 unplanned post-operative ICU admissions were reviewed. During pre-operative evaluation, 72% (n=18) of patients were identified as American Society of Anesthesiologists (ASA) Class 3. On average, patients were seen by 4.8 specialties in the outpatient setting over the previous year. Patients also were noted to have a high number of pre-admission medications, averaging 8.58. 60% (n=15) of patients were receiving gastrostomy tube feeds prior to admission. 56% (n=14) of patients had an underlying respiratory condition for which 9 required oxygen at home and 3 had tracheostomies. 12% (n=3) of patients had ventriculoperitoneal shunt and 36% (n=9) had a seizure disorder. Only 7 of the patients had a history of prematurity. We also identified specific systemic co-morbidities (Figure 1) and "complexity score" (Figure 2) distribution for the cohort.

Conclusion/Discussion: Creating a validated scoring system for admitting patients to SCM is critical so that we can focus our resources on patients at highest risk of post-operative outcomes. This retrospective review is the first step of this process by identifying specific factors associated with patients who had unplanned ICU admission(s).