910 www.ccmjournal.org฀ April฀2014฀•฀Volume฀42฀•฀Number฀4 Objective:฀ ICU฀ needs฀ of฀ nontrauma฀ emergency฀ general฀ surgery฀ patients฀are฀poorly฀described.฀This฀study฀was฀designed฀to฀com- pare฀ICU฀utilization฀of฀emergency฀general฀surgery฀patients฀admit- ted฀to฀an฀acute฀care฀emergency฀surgery฀service฀with฀other฀general฀ surgery฀patients.฀Our฀hypothesis฀is฀that฀tertiary฀care฀emergency฀ general฀ surgery฀ patients฀ utilize฀ more฀ ICU฀ resources฀ than฀ other฀ general฀surgical฀patients. Design:฀Retrospective฀database฀review. Setting:฀Academic,฀tertiary฀care,฀nontrauma฀surgical฀ICU. Patients:฀ All฀ patients฀ admitted฀ to฀ the฀ surgical฀ ICU฀ over฀ age฀ 18฀ between฀March฀2004฀and฀June฀2012. Interventions:฀None. Measurements and Main Results:฀Six฀thousand฀ninety-eight฀patients฀ were฀evaluated:฀1,053฀acute฀care฀emergency฀surgery,฀1,964฀general฀ surgery,฀1,491฀transplant฀surgery,฀995฀facial฀surgery/otolaryngology,฀ and฀595฀neurosurgery.฀Acute฀care฀emergency฀surgery฀patients฀had฀ statistically฀signifcantly฀longer฀ICU฀lengths฀of฀stay฀than฀other฀groups:฀ acute฀ care฀ emergency฀ surgery฀ (13.5฀±฀17.4฀ d)฀ versus฀ general฀ sur- gery฀ (8.7฀±฀12.9),฀ transplant฀ (7.8฀±฀11.6),฀ oral-maxillofacial฀ surgery฀ (5.5฀±฀4.2),฀and฀neurosurgery฀(4.47฀±฀9.8)฀(all฀ p <฀ 0.01).฀ Ventilator฀ usage,฀ defned฀ by฀ percentage฀ of฀ total฀ ICU฀ days฀ patients฀ required฀ mechanical฀ventilation,฀was฀signifcantly฀higher฀for฀acute฀care฀emer- gency฀surgery฀patients:฀acute฀care฀emergency฀surgery฀73.4%฀versus฀ general฀surgery฀64.9%,฀transplant฀63.3%,฀oral-maxillofacial฀surgery฀ 58.4%,฀ and฀ neurosurgery฀ 53.1%฀ (all฀ p฀ <฀ 0.01).฀ Continuous฀ renal฀ replacement฀therapy฀usage,฀defned฀as฀percent฀of฀patients฀requiring฀ this฀ service,฀ was฀ signifcantly฀ higher฀ in฀ acute฀ care฀ emergency฀ sur- gery฀patients:฀acute฀care฀emergency฀surgery฀10.8%฀versus฀general฀ surgery฀ 4.3%,฀ transplant฀ 6.6%,฀ oral-maxillofacial฀ surgery฀ 0%,฀ and฀ neurosurgery฀ 0.5%฀ (all฀ p฀ <฀ 0.01).฀ Acute฀ care฀ emergency฀ surgery฀ patients฀were฀more฀likely฀interhospital฀transfers฀for฀tertiary฀care฀ser- vices฀than฀general฀surgery฀or฀transplant฀(24.5%฀vs฀15.5%฀and฀8.3%฀ respectively,฀p฀<฀0.001฀for฀each)฀and฀more฀likely฀required฀emergent฀ surgery฀(13.7%฀vs฀6.7%฀and฀3.5%,฀all฀p฀<฀0.001).฀Chronic฀comor- bidities฀ were฀ similar฀ between฀ acute฀ care฀ emergency฀ surgery฀ and฀ general฀surgery,฀whereas฀transplant฀had฀fewer. Conclusions:฀Emergency฀general฀surgery฀patients฀have฀increased฀ ICU฀needs฀in฀terms฀of฀length฀of฀stay,฀ventilator฀usage,฀and฀con- tinuous฀ renal฀ replacement฀ therapy฀ usage฀ compared฀ with฀ other฀ services,฀perhaps฀due฀to฀the฀higher฀percentage฀of฀transfers฀and฀ emergent฀ surgery฀ required.฀ These฀ patients฀ represent฀ a฀ distinct฀ population.฀ Understanding฀ their฀ resource฀ needs฀ will฀ allow฀ for฀ better฀ deployment฀ of฀ hospital฀ resources.฀ (Crit Care Med 2014; 42:910–917) Copyright฀©฀2013฀by฀the฀Society฀of฀Critical฀Care฀Medicine฀and฀Lippincott฀ Williams฀&฀Wilkins DOI: 10.1097/CCM.0000000000000099 1 Department฀of฀Surgery฀and฀Program฀in฀Trauma,฀R฀Adams฀Cowley฀Shock฀ Trauma฀Center,฀University฀of฀Maryland฀School฀of฀Medicine,฀Baltimore,฀MD. 2 Department฀of฀Anesthesiology฀and฀Program฀in฀Trauma,฀R฀Adams฀Cowley฀ Shock฀Trauma฀Center,฀University฀of฀Maryland฀School฀of฀Medicine,฀Balti- more,฀MD. 3 Department฀ of฀ Clinical฀ Effectiveness,฀ University฀ of฀ Maryland฀ Medical฀ Center,฀Baltimore,฀MD. 4 Department฀ of฀ Anesthesiology,฀ University฀ of฀ Maryland฀ School฀ of฀ Medi- cine,฀Baltimore,฀MD. This฀work฀was฀performed฀at฀the฀University฀of฀Maryland฀Medical฀Center฀and฀ the฀University฀of฀Maryland฀School฀of฀Medicine. Dr.฀ Lissauer฀ received฀ support฀ for฀ travel฀ (surgery฀ section฀ travel฀ grant฀ to฀ present฀the฀poster฀of฀this฀work฀at฀the฀Society฀of฀Critical฀Care฀Medicine฀ 42nd฀Critical฀Care฀Congress)฀and฀is฀employed฀by฀Shock฀Trauma฀Associ- ates,฀PA,฀and฀the฀University฀of฀Maryland฀Faculty฀Physicians.฀His฀institution฀ received฀grant฀support฀from฀Braun฀Corp.฀(research฀contract฀to฀study฀the฀ effect฀of฀endotoxin฀removal฀via฀the฀BRAUN฀S.A.F.E.฀BT฀therapy฀device),฀ Astute฀ Medical฀ (research฀ contract฀ to฀ study฀ the฀ early฀ diagnosis฀ of฀ acute฀ kidney฀injury),฀and฀Pfzer฀Corp.฀(research฀contract฀to฀study฀apixaban฀in฀the฀ treatment฀of฀deep฀vein฀thrombosis/pulmonary฀embolus).฀Dr.฀Galvagno฀Jr฀ served฀ as฀ a฀ board฀ member฀ with฀ the฀ American฀ Board฀ of฀ Anesthesiology฀ (Critical฀Care฀Medicine฀test฀writing฀committee);฀is฀employed฀by฀the฀Uni- versity฀of฀Maryland฀Faculty฀Physicians฀and฀Shock฀Trauma฀Associates,฀PA;฀ and฀received฀support฀for฀development฀of฀educational฀presentations฀from฀ the฀Society฀of฀Critical฀Care฀Medicine฀(Airway฀Webinar,฀2013)฀and฀United฀ States฀Air฀Force฀Reserve฀(Reservist฀in฀United฀States฀Air฀Force.฀His฀institu- tion฀received฀grant฀support:฀ECI12052฀(Co-I,฀Ultrasonographic฀measures฀ of฀volume฀responsiveness)฀and฀NCT01545232฀(Pragmatic,฀Randomized฀ Optimal฀Platelets฀and฀Plasma฀Ratios).฀Dr.฀Rock’s฀institution฀received฀sup- port฀ from฀ the฀ National฀ Institutes฀ of฀ Health.฀ Dr.฀ Narayan฀ is฀ employed฀ by฀ the฀Shock฀Trauma฀Associates,฀PA,฀and฀the฀State฀of฀Maryland.฀Dr.฀Shah฀is฀ employed฀by฀the฀Shock฀Trauma฀Associates,฀PA,฀and฀Faculty฀Physicians.฀ Ms.฀Spencer฀is฀employed฀by฀the฀University฀of฀Maryland฀Medical฀Center.฀ Dr.฀Hong฀is฀employed฀by฀the฀University฀of฀Maryland฀Anesthesiology฀Asso- ciates,฀PA,฀and฀received฀grant฀support฀from฀the฀American฀Heart฀Associa- tion฀and฀the฀United฀States฀Air฀Force/University฀of฀Maryland฀Cooperative฀ Agreement฀Award.฀Dr.฀Diaz฀consulted฀for฀Acute฀Innovations,฀LifeCell,฀and฀ Synthes฀and฀provided฀expert฀testimony฀for฀several฀organizations. For฀information฀regarding฀this฀article,฀E-mail:฀mlissauer@umm.edu Increased ICU Resource Needs for an Academic Emergency General Surgery Service* Matthew E. Lissauer, MD, FACS 1 ; Samuel M. Galvagno Jr, DO, PhD, MS 2 ; Peter Rock, MD, MBA, FCCM 2 ; Mayur Narayan, MD, MPH, MBA 1 ; Paulesh Shah, MD 1 ; Heather Spencer, RN, MS, MBA 3 ; Caron Hong, MD 4 ; Jose J. Diaz, MD, FACS, FCCM 1