Medicine versus surgery/anesthesiology intensivists: a retrospective review and comparison of outcomes in a mixed medical–surgical–trauma ICU

• Published in: Canadian Journal of Surgery 2013-08, Vol.56 (4), p.275-279
• Main Authors: James Lee, B. Eng, MD, Iqbal, Sameena, MD, Gursahaney, Ash, MD, Nouh, Thamer, MBBS, Khwaja, Kosar, MD, MBA, MSc
• Format: Article
• Language: English
• Subjects: Academic Medical Centers; Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Analysis; Anesthesiology; APACHE; Canada; Care and treatment; Causes of; Clinical competence; Clinical outcomes; Comparative studies; Female; General Surgery; Hospital Mortality; Hospitals, Teaching; Humans; Intensive care; Intensive Care Units; Internal Medicine; Length of Stay; Male; Medical Staff, Hospital; Middle Aged; Mortality; Physicians; Proportional Hazards Models; Quebec; Retrospective Studies; Services; Surgery; Trauma centers; Wounds and injuries; Young Adult
• ISSN: 0008-428X; 1488-2310
• DOI: 10.1503/cjs.005412

Background With various types of complex patients being treated in a mixed medical–surgical–trauma intensive care unit (ICU), we hypothesized that there should be no difference in patient mortality with respect to the core training of the intensivist. Methods We reviewed the cases of all patients admitted to a mixed medical–surgical–trauma ICU at a Canadian university teaching hospital in 2007. Patients were assigned to 1 of 2 treatment groups (internal medicine, surgery/anesthesiology) based on the treating intensivist’s training. Our primary outcome was to compare patient mortality in the ICU between the groups. We used generalized estimating equations to determine 10-day mortality after admission to the ICU. A multivariate Cox hazard model was used to determine statistical significance and 95% confidence intervals (CIs) for 11- to 60-day mortality in the ICU. Results A total of 961 patients were admitted from January to December, 2007. We found no significant difference between the groups in 10-day mortality (odds ratio 0.73, 95% CI 0.46–1.18, p = 0.20) and 11- to 60-day mortality (hazard ratio 1.43, 95% CI 0.62–3.30, p = 0.40) after admission to the ICU. Conclusion In a large university trauma centre that operates a mixed medicine–surgical–trauma ICU, there was no significant difference in mortality between patients managed by intensivists with core training in internal medicine and those managed by intensivists with training in surgery/anesthesiology.