Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Clinical Research

Referral to immediate post-operative care in an intensive care unit from the perspective of anesthesiologists, surgeons, and intensive care physicians: a cross-sectional questionnaire

Indicação de cuidados pós-operatórios imediatos em unidade de terapia intensiva sob a perspectiva de anestesistas, cirurgiões e intensivistas: questionário transversal

João M. Silva Junior, Henrique Tadashi Katayama, Felipe Manuel Vasconcellos Lopes, Diogo Oliveira Toledo, Cristina Prata Amendola, Fernanda dos Santos Oliveira, Leusi Magda Romano Andraus, Suzana Margareth Lobo, Luiz Marcelo Sá Malbouisson

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Introduction and objective
Due to the high cost and insufficient offer, the request for Intensive Care (ICU) beds for post-operative recovery needs adequate criteria. Therefore, we studied the characteristics of patients referred to post-operative care at an ICU from the perspective of anesthesiologists, surgeons, and intensive care physicians.

A questionnaire on referrals to post-operative intensive care was applied to physicians at congresses in Brazil. Anesthesiologists, surgeons, and intensive care physicians who agreed to fill out the questionnaire were included. The questionnaire consisted of hypothetical clinical scenarios and cases for participants to choose which would be the priority for referral to the ICU.

360 physicians participated in the study, with median time of 10 (5–18) years after graduation. Of the interviewees, 36.4% were anesthesiologists, 30.0% surgeons, and 33.6% intensive care physicians. We found that anesthesiologists were more conservative, and surgeons less conservative in ICU referrals. As to patients with risk of bleeding, 75.0% of the surgeons would refer them to the ICU, in contrast with 52.1% of the intensive care physicians, and 43.5% of the anesthesiologists (p < 0.001). As to elderly persons with limited reserve, 62.0% of the surgeons would refer them to the ICU, in contrast with 47.1% of the intensive care physicians, and 22.1% of the anesthesiologists (p < 0.001). As to patients with risk of respiratory complications, 64.5% of the surgeons would recommend the ICU, versus 43.0% of the intensive care physicians, and 32.1% of the anesthesiologists (p < 0.001). Intensive care physicians classified priorities better in indicating ICU, and the main risk indicator was the ASA physical status in all specialties (p < 0.001). There was no agreement among the specialties and surgeries on prioritizing post-operative intensive care.

Anesthesiologists, surgeons, and intensive care physicians presented different perspectives on post-operative referral to the ICU.


Surgical procedures,  Post-operative care,  Patient selection criteria,  Intensive care,  Anesthesiologists,  Surgeons


1 L. Blanch, F.F. Abillama, P. Amin, et al. Triage decisions for ICU admission: report from the Task Force of the World Federation of Societies of Intensive and Critical Care Medicine J Crit Care, 36 (2016), pp. 301-305

2 J.M. Silva Jr., H.M. Rocha, H.T. Katayama, et al. SAPS 3 score as a predictive factor for postoperative referral to intensive care unit Ann Intensive Care, 6 (2016), p. 42

3 J.L. Nates, M. Nunnally, R. Kleinpell, et al. ICU admission, discharge, and triage guidelines: a framework to enhance clinical operations, development of institutional policies, and further research Crit Care Med, 44 (2016), pp. 1553-1602

4 V.M. Caldeira, J.M. Silva Junior, A.M. Oliveira, et al. Criteria for patient admission to an intensive care unit and related mortality rates Rev Assoc Med Bras (1992), 56 (2010), pp. 528-534

5 G. Smith, M. Nielsen ABC of intensive care. Criteria for admission BMJ, 318 (1999), pp. 1544-1547

6 E. Forward, P. Konecny, J. Burston, et al. Predictive validity of the qSOFA criteria for sepsis in non-ICU inpatients Intensive Care Med, 43 (2017), pp. 945-946

7 J. Orsini, C. Blaak, B. Shamian, et al. Assessing the utility of ICU admission for octogenarians Aging Clin Exp Res, 28 (2016), pp. 745-751

8 E. Solligard, J.K. Damas SOFA criteria predict infection-related in-hospital mortality in ICU patients better than SIRS criteria and the qSOFA score Evid Based Med, 22 (2017), p. 211

9 E.D. Silva, A.C. Perrino, A. Teruya, et al. Brazilian consensus on perioperative hemodynamic therapy goal guided in patients undergoing noncardiac surgery: fluid management strategy - produced by the São Paulo State Society of Anesthesiology (Sociedade de Anestesiologia do Estado de São Paulo - SAESP) Rev Bras Anestesiol, 66 (2016), pp. 557-571

10 J.R. Rocco, M. Soares, F. Gago Mde Referred medical patients not admitted to the Intensive Care Unit: prevalence, clinical characteristics and prognosis Rev Bras Ter Intensiva, 18 (2006), pp. 114-120

11 C. Franklin, E.C. Rackow, B. Mamdani, et al. Triage considerations in medical intensive care Arch Intern Med, 150 (1990), pp. 1455-1459

12 E. Simchen, C.L. Sprung, N. Galai, et al. Survival of critically ill patients hospitalized in and out of intensive care units under paucity of intensive care unit beds Crit Care Med, 32 (2004), pp. 1654-1661

13 E.E. Vasilevskis, R. Chandrasekhar, C.H. Holtze, et al. The cost of ICU delirium and coma in the intensive care unit patient Med Care, 56 (2018), pp. 890-897

14 L.Y. Yamauchi Cost analysis in the ICU from the standpoint of physical therapy J Bras Pneumol, 44 (2018), p. 175

15 Guidelines for intensive care unit admission, discharge, and triage. Task force of the American College of Critical Care Medicine, Society of Critical Care Medicine Crit Care Med, 27 (1999), pp. 633-638

16 T. Sinuff, K. Kahnamoui, D.J. Cook, et al. Rationing critical care beds: a systematic review Crit Care Med, 32 (2004), pp. 1588-1597

17 Consensus statement on the triage of critically ill patients. Society of Critical Care Medicine Ethics Committee JAMA, 271 (1994), pp. 1200-1203

18 M.F. Marshall, K.J. Schwenzer, M. Orsina, et al. Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds Crit Care Med, 20 (1992), pp. 387-394

19 J.M. Silva Junior, R.C.F. Chaves, T.D. Correa, et al. Epidemiology and outcome of high-surgical-risk patients admitted to an intensive care unit in Brazil Rev Bras Ter Intensiva, 32 (2020), pp. 17-27

20 T.L. Higgins, W.T. McGee, J.S. Steingrub, et al. Early indicators of prolonged intensive care unit stay: impact of illness severity, physician staffing, and pre-intensive care unit length of stay Crit Care Med, 31 (2003), pp. 45-51

21 J.M. Silva Junior, L.M. Malbouisson, H.L. Nuevo, et al. Applicability of the simplified acute physiology score (SAPS 3) in Brazilian hospitals Rev Bras Anestesiol, 60 (2010), pp. 20-31

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