Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For patients undergoing major surgical procedures, what is the comparative effectiveness of post-operative ICU care vs non-ICU care?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

There are considerable variations across hospitals and geographic regions in the utilization of ICU care within patients undergoing the same surgical procedures. The lack of standardized protocol/guidelines for ICU admission after surgery has profound implication for healthcare cost and quality.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

All inpatients undergoing major surgical procedures.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Quality postoperative care may lower surgical and anesthesia complications, e.g., infections, respiratory failure, renal functional impairment, acute kidney injury, cardiac arrest, etc.

Describe any health-related risks, side effects, or harms that you are concerned about.

I am concerned about the wide array of postoperative complications patients may experience.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

unsure

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Cancer
• Cardiovascular disease, including stroke and hypertension
• Pregnancy, including preterm birth
• Pulmonary disease/asthma

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children
• Elderly

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)
• Other

Importance

Describe why this topic is important.

ICU is among the most expensive care and the scarcest resources. Over 20% of all surgery patients are sent to ICU after surgery.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

There is an emerging literature on the clinical decision rules for optimizing postoperative disposition. Simple quantitative tools, such as the Surgical Apgar Score, have shown great potential for aiding clinical decisions on whether a patient should be sent to ICU after surgery.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Evidence-based clinical decision rules and guidelines can be effective tools for aiding clinical decisions but cannot substitute for clinical judgment. Inherent in clinical judgment is some degree of uncertainty.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

A simple, quantitative scoring system that is valid and reliable in measuring the need for postoperative admission to ICU could be used by all surgeons, anesthesiologists, and intensivists.

Describe the timeframe in which an answer to your question is needed.

2-3 years for developing the scoring system and 1-2 years for implementing and evaluating the system

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Appropriate use of ICU care may help improve equity in access to this scarce resource and surgical outcomes across socioeconomic strata.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

A simple, quantitative scoring system that is valid and reliable in measuring the need for postoperative admission to ICU could be used by all surgeons, anesthesiologists, and intensivists.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

e-newsletter of AHRQ