Factors Associated with Mortality in Surgical Patients Admitted to a Low-Resource Mixed Intensive Care Unit: A Cross-Sectional Study

Factors Associated with Mortality in Surgical Patients Admitted to a Low-Resource Mixed Intensive Care Unit: A Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors Associated with Mortality in Surgical Patients Admitted to a Low-Resource Mixed Intensive Care Unit: A Cross-Sectional Study Jacques Fadhili Bake, Kambere Mukama Phalek, Mumbere Kigayi Jean-Pierre, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5968698/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Surgery → Version 1 posted 12 You are reading this latest preprint version Abstract Background Providing critical care is essential for improving health outcomes, particularly in low-resource settings such as the Democratic Republic of the Congo (DRC). However, there is a significant lack of data regarding the management and outcomes of surgical critically ill patients in this region. This study aimed to investigate the factors associated with mortality among surgical patients admitted to the intensive care unit (ICU) at HEAL Africa Hospital in eastern DRC. Methods This retrospective cross-sectional study analyzed data from surgical patients admitted to the ICU between January 2021 and June 2023. Information was extracted from the ICU registry, including demographics, reasons for admission, management details, length of stay, and mortality rates. Categorical data were presented as frequencies, and logistic regression was used, with a p-value of less than 0.05 considered significant. Results Out of 807 patients admitted to the ICU, 368 were surgical patients (43.12%). The cohort had a male predominance (1.6:1) with a median age of 31 years. The primary reason for admission was postoperative monitoring (57.2%). The overall mortality rate was 21.3%. Univariate analysis identified statistically significant risk factors for increased mortality: male sex (p = 0.004), age (p = 0.0409), need for mechanical ventilation (p < 0.0001), involvement in neurosurgery (p = 0.03), and non-operative management (p < 0.0001). Multivariate analysis confirmed that the need for mechanical ventilation (p < 0.0001) and the non-operative management (p < 0.0001) was significantly associated with increased mortality. Conclusion The burden of surgical critically ill patients in eastern DRC is substantial. Non-operative management and the requirement for mechanical ventilation were identified as factors influencing mortality among these patients. To tackle this pressing issue, it is essential to enhance critical care protocols, invest in the training of healthcare professionals, and allocate resources effectively. Clinical trial number: not applicable. Intensive care unit Heal Africa Hospital Mortality Critical Surgical Patient BACKGROUND The Intensive Care Unit (ICU) is a specialized department where critically ill patients receive continuous monitoring and treatment around the clock. Its primary objective is to restore and sustain the function of vital organs, thereby enhancing the likelihood of survival. This unit is regarded as a central hub, capable of accommodating patients from various medical specialties. [1–3]. To ensure the provision of high-quality primary healthcare, it is crucial to integrate emergency services, critical care, and surgical care [4]. An effectively organized system of these services is crucial for achieving the diverse objectives linked to the third Sustainable Development Goal, which seeks to ensure healthy lives and promote well-being for everyone, particularly in relation to universal health coverage [4,5]. Most healthcare facilities in sub-Saharan Africa lack intensive care services, and when such services are available, they are often quite rudimentary [6,7]. The Coronavirus disease (COVID)-19 health crisis has highlighted significant deficiencies in emergency services, critical care, and surgical care, resulting in considerable avoidable mortality and morbidity on a global scale. In March 2020, the DRC faced the dual challenges of the COVID-19 pandemic and an Ebola outbreak. These concurrent crises exposed a stark lack of essential resources within healthcare facilities, particularly regarding equipment necessary for intensive care [4,8]. In addition to these health crises, the DRC, particularly the North Kivu province, has faced significant health challenges due to armed conflicts, natural disasters, and limited healthcare infrastructure [9,10]. Statistical data indicate that at least 4.2 million individuals die each year within 30 days following a surgical procedure globally, with half of these fatalities occurring in low- or middle-income countries [11]. In numerous circumstances, patients, their relatives, and even healthcare professionals frequently place significant emphasis on the technical aspects of a surgical procedure. However, it is essential to highlight that establishing an optimal perioperative practice is equally critical as the specific technical issues encountered in the surgical field during the execution of the surgical intervention [12,13]. There is a lack of data regarding the mortality of surgical patients admitted to intensive care units in the North Kivu, a province of eastern DRC, particularly in Goma, the provincial capital. A study aimed at collecting and analyzing information on the factors associated with the mortality of surgical patients in intensive care could address this gap. Understanding these factors could enhance health service planning, resource allocation, and the development of treatment protocols tailored to local needs. MATERIAL AND METHODS Study area and period This study was conducted at HEAL Africa Hospital, a university hospital located in Goma, the capital of the North Kivu province in the eastern part of the DRC, during the period from January 1, 2021, to June 30, 2023. It is equipped with 260 beds, which include 6 beds designated for the adult and children intensive care unit, neonate requiring intensive care have their separate units in the neonatal department. This is a mixed intensive care unit accommodating patients from all departments requiring intensive care. In terms of essential equipment, there are four functional ventilators in the intensive care unit, along with wall-mounted oxygen, oxygen cylinders, and oxygen concentrators available as needed. Multiparameter monitors are also present and mounted on the walls next to each bed. Population and sampling In the context of this research, a comprehensive sampling of all surgical patients admitted to the intensive care unit at HEAL Africa Hospital was conducted. The inclusion criteria encompassed patients of all ages and sex with various general surgical conditions admitted to the intensive care unit during the study period. Conversely, the exclusion criteria consisted of female patients who underwent surgery for gynecological or obstetrical issues, as well as patients whose critical data were missing. Types of study and data collection and analysis This is a retrospective cross-sectional study. Data were obtained from the admission and discharge registry of patients admitted to the ICU, facilitating the inclusion of demographic information such as age, sex, originating department, relevant subspecialty, diagnosis, received treatment, types of operations performed, mechanical ventilation use, length of stay in the ICU, and mortality rates. The ICU registry is under the oversight of the head nurse of the ICU, who serves as the primary authority responsible for ensuring data quality. He ensures that the data captured in the registry is accurate and reliable. All of this information was directly entered into Excel software to prepare it for statistical analysis using Statistical Package for Social Sciences (SPSS) 26 [IBM, Armonk, NY] for Windows. Logistic regression was chosen as the outcome variable (ICU mortality) is binary (alive/dead). Variables Dependent Variable ICU mortality: Binary (1 = death, 0 = survival). Independent Variables Variables were selected based on clinical relevance and availability in the ICU registry: Demographics: Age, sex, originating department. Clinical and management factors: Diagnosis, Subspeciality, Need for mechanical ventilation (binary: yes/no), 0perative management (binary: surgical vs. non-surgical), Type of surgery. Operational factors: Length of ICU stay, reason for admission. Univariate Analysis: Each variable was tested individually for association with mortality using univariate logistic regression. Multivariate Analysis: Variables with p < 0.05 in univariate analysis were included in a multivariable logistic regression model to adjust for confounding. RESULTS From January 1, 2021, to June 30, 2023, a total of 807 critically ill patients were admitted to the mixed intensive care unit at HEAL Africa Hospital. Of these, 368 patients (43.12%) were surgical cases, originating from the operating room, emergency department, and general hospitalization. However, 20 patients were excluded from the analysis due to missing data. Among the 348 participants included in this study, 74 individuals (21.26%) had succumbed to their conditions. Demographic characteristics and mortality The majority of patients admitted to intensive care were male, comprising 217 individuals (62.4%), resulting in a male-to-female ratio of 1.6:1. The median age of the participants was 31 years, with an interquartile range of 20 to 46 years. Ages among the patients varied from 1 year to 85 years. A significant proportion of patients (69.3%) were admitted from the operating room (see Table 1 ). Table 1 Demographic characteristics of patients and mortality rates. Total n (%) Died n (%) Survived n (%) OR (95% CI) p-value Variables Total 348 (100) 74 (21.3) 274 (78.7) - - Sex Female 131 (37.6) 17 (13.0) 114 (87.0) - - Male 217 (62.3) 57 (26.3) 160 (73.7) 2.4 (1.3–4.3) 0.004 Age Mean (SD) 33 (20–46) 35 (23–47) 31 (18–45) - 0.07 Originating department Operating room 241 (69.2) 28 (11.6) 213 (88.4) 1,0 - Emergency room 94 (27.0) 41 (43.6) 53 (56.4) 5.8 (3.2–11) < 0.001 Hospitalization 13 (3.7) 5 (38.5) 8 (61.5) 4.7 (1.1–18) 0.02 SD: Standard deviation A statistically significant association was noted between patient sex and mortality, with males exhibiting a higher risk of death in the intensive care unit compared to females (odds ratio (OR): 2.4, 95% confidence interval (CI): 1.3–4.3, p = 0.004). Additionally, a statistically significant relationship was observed between the source of patient admission and mortality. Patients admitted from the emergency department (p < 0.0001) and those from inpatient wards (p = 0.02) had a higher OR of mortality in the ICU compared to those admitted from the operating room (see Table 1 ). Clinical Features and Mortality Rates A significant proportion of patients (54.6%) were sourced from the general surgery subspecialty. The predominant cause for admission to the ICU was postoperative monitoring, which was noted in 57.2% of patients (see table 2). Tableau 2. Clinical characteristics and mortality Total n (%) Died n (%) Survived n (%) OR (95% CI) p-value Variables Total 348 (100) 74 (21.3) 274(78.7) - - Diagnostic < 0.001 Others 5 (1.4) 0 (0.0) 5 (100) 1.0 (0.000-.) 1 Cleft lip and palate 8 (2.3) 0 (0.0) 8 (100) 1.0 (0.000-.) 1 Low limb gangrene 7 (2.0) 2 (28.6) 5 (71.4) 1.899E-8 (3.557E-9-1.014E-7) < 0.001 GI bleeding 3 (0.9) 3 (100) 0 (0.0) 2.725E-17 (0.000-.) 0.997 Pancreatitis 6 (1.7) 2 (33.3) 4 (66.7) 1.519E-8(2.690E-9-8.584E-8) < 0.001 Bowel obstruction 19 (5.5) 2 (10.5) 17 (89.5) 6.458E-8 (1.434E-8-2.908E-7) < 0.001 Colorectal conditions 12 (3.4) 0 (0.0) 12 (100) 1.0 (0.000-.) < 0.001 Brain abscess 5 (1.4) 2 (40.0) 3 (60.0) 1.140E-8 (1.843E-9-7.045E-8) < 0.001 Skin and subcutaneous conditions 11 (3.2) 0 (0.0) 11 (100) 1.0 (0.000-.) 1 Upper airways obstruction 9 (2.6) 2 (22.2) 7 (77.8) 2.659E-8 (5.324E-9-1.328E-7) < 0.001 Gastroduodenal ulcer 8 (2.3) 3 (37.5) 5 62.5 1.266E-8 (2.906E-9-5.517E-8) < 0.001 Non-traumatic Orthopedic conditions 16 (4.6) 1 (6.3) 15 (93.7) 1.140E-7 (1.463E-8-8.879E-7) < 0.001 Goiter 6 (1.7) 0 (0.0) 6 (100) 1.0 (0.000-.) 1 Peritonitis 55 (15.8) 11 (20.0) 44 (80.0) 3.039E-8 (1.444E-8-6.396E-8) < 0.001 Trauma 160 (46.0) 46 (28.7) 114 (71.3) 1.883E-8 (1.883E-8-1.883E-8) - Iatrogenic ureteric injury 18 (5.2) 0 (0.0) 18 (100) 1.0 - Subspeciality < 0.0001 General surgery 190 (54.6) 42 (30) 148 (70) 1.0 - Neurosurgery 79 (22.7) 28 (35) 51 (65) 1.9 (1.0-3.6) 0.03 Orthopedics 52 (14.9) 4 (7.7) 48 (92.3) 0.3(0.1–0.9) 0.02 Urology 18 (5.2) 0 (0.0) 18 (100) - 0.03 Plastic surgery 9 (2.6) 0 (0.0) 9 (100) - 0.02 Length of stay Median (IQR) 2 (1–4) 2 (1–5) 2 (1–4) - 0.06 Reason of < 0.0001 admission Post op monitoring 199(57.2) 16 (8.0) 183 (92.0) 1.0 - Polytrauma 80 (23.0) 31 (38.7) 49 (61.3) 7.2(3.5–15) < 0.0001 Severe sepsis 44 (12.6) 13 (29.6) 31(70.4) 4.8 (1.9–12) 0.0003 Respiratory distress 21 (6.0) 10 (47.6) 11 (52.4) 10 (3.3–31) 0.99 IQR: Interquartile range A statistically significant relationship is identified between the admission diagnosis (p < 0.0001), surgical subspecialty (p < 0.0001), the reason for intensive care admission (p < 0.0001), and mortality outcomes (see table 2). Therapeutic factors and mortality A significant proportion of patients admitted to the ICU had undergone surgical procedures, accounting for 80.7% of the total population, while 19.3% received conservative treatment. In total, 58 patients required mechanical ventilation, representing 16.7% of the overall population (see table 3). Tableau 3. Therapeutic factors and mortality Total n (%) Died n (%) Survived n (%) OR (95% CI) p-value Variables Total 348 (100) 74 (21.3) 274 (78.7) - - Mechanical ventilation No 290 (83.3) 25 (8.6) 265 (91.4) 1.0 - Yes 58 (16.7) 49 (84.5) 9 (15.5) 56 (24–147) < 0.0001 Type of management Surgical 281(80.7) 40 (14.2) 241(85.8) 1.0 - Conservative 67 (19.3) 34 (50.7) 33 (49.3) 6.2 (3.3–12) < 0.0001 The odds of mortality in ICU were found to be 56 times greater for patients who were placed on ventilators (p < 0.0001). Additionally, it was observed that surgical patients who did not undergo any surgical procedures had an OR of 6.2 for mortality in intensive care compared to those who did undergo surgery (p < 0.0001) (see table 3). DISCUSSION This study primarily aimed to identify the factors associated with mortality among patients with surgical conditions admitted to the ICU of HEAL Africa Hospital. More specifically, we sought to determine the demographic, clinical, and therapeutic characteristics linked to the mortality of these patients. This study revealed a mortality rate of 21.26% among surgical patients admitted to intensive care. This figure is comparable to those observed in Lubumbashi (19.8%), Yemen (20%), and South Africa (22.4%) [14–16]. On the other hand, it is lower than the mortality rates reported by Endeshaw et al. (45%) in Ethiopia, Rad (39.8%) in Ethiopia, Zhang et al. (32.6%) in China, and Ahmed et al. (51%) in Bangladesh [17–20]. The observed difference can be attributed to the specific characteristics of the studied population. Our analysis indicates that a significant proportion of patients admitted to the ICU were actually in a phase of postoperative monitoring. This postoperative observation is influenced not only by the complexity of the surgical procedures undergone by the patients but also by organizational constraints, such as a reduced availability of nursing staff in the recovery room for surgeries conducted later in the day. This practice contrasts with that seen in many other intensive care units, where admissions are more closely associated with the severity of the patients' illnesses or the complexity of the surgeries performed [21–23]. Demographic characteristics and mortality Our study indicates a significantly higher mortality rate among men, with a p-value of 0.004. However, numerous previous studies have not demonstrated any significant variation in mortality rates [16,19,24,25]. The observed differences within our study population can be ascribed to the varying pathologies identified in males and females. Males are more frequently affected by polytrauma and neurosurgical conditions. Furthermore, hormonal disparities between male and female individuals may impact the body's response to severe illness and affect recovery rates. For instance, it is hypothesized that the estrogen present in females exerts positive effects on cardiovascular health and immune response [26]. It has been observed that age does not play a significant role in mortality (p = 0.07). This finding aligns with the results of several other studies that have similarly demonstrated the lack of influence of age on mortality [19,22,23,25]. However, further research has highlighted a high mortality rate among older individuals. Indeed, the literature links an age greater than 65 years to various comorbidities, including cardiovascular, pulmonary, metabolic, and neurological diseases. Additionally, their immune system may be compromised, resulting in a less effective inflammatory response during stressful situations such as surgery. This stress increases the risk of severe complications and mortality [27,28]. Our findings can be attributed to the demographic composition of our study population, which predominantly consisted of younger individuals. The age distribution within the Congolese population reveals that approximately 55.7% of individuals are 19 years old or younger, 41.2% fall within the age range of 20 to 64 years, and merely 3.1% are aged 65 years or older [29]. In the course of this research, it was noted that the majority of surgical patients admitted to the ICU originated from the operating room. Patients arriving from the emergency department exhibited a significantly higher risk of mortality compared to those coming from inpatient wards or the operating room (p < 0.0001). These findings contrast with those reported by other authors, who observed that most patients admitted to ICU were sourced from emergency services [23,30,31]. In addition to the previously mentioned reasons, it is crucial to emphasize that patients arriving from emergency services who require surgical intervention are primarily directed to the operating room. This categorizes them more as operating room patients rather than emergency patients. Consequently, this practice diminishes the number of admissions from emergency services for our study. Clinical characteristics and mortality The findings of this study suggest that patients within the field of neurosurgery exhibit a higher mortality rate compared to those from other specialties. This observation aligns with the results of a previous study conducted in Ethiopia [32]. This situation can be attributed to the fact that the majority of our patients admitted for neurosurgical conditions experience severe head trauma, which are linked to a high risk of mortality in intensive care, as highlighted by several authors [17,30,33,34]. The primary reason for admission to ICU was postoperative monitoring, a finding that aligns with the results of Endeshaw et al. in Ethiopia, who also noted this trend [17]. Numerous other authors have recognized various diagnostic categories as reasons for admission [23,31,35]. There is also no association whatsoever between mortality and the reason for admission to the intensive care unit. [23]. This situation can be attributed to the disparities in the studied population and the criteria for admission to ICU, which differ from one institution to another. For instance, in our study, the lack of a nurse for the postoperative monitoring of patients who underwent surgery late in the day may lead to the admission of a patient to the ICU without any other justification for such admission. The findings of this study indicated that there was no statistically significant impact of the length of stay in the ICU on mortality rates. These conclusions contradict the results reported by other researchers who found a significant relationship between length of stay and mortality [23,25]. According to these authors, an extended stay is a factor that increases mortality in ICU. In our study, the lack of a significant impact of length of stay on mortality may be attributed to the average short duration of 2 days that our patients spent in intensive care. This is further elucidated by the observation that most of our patients were admitted for postoperative monitoring. Therapeutic factors and mortality In this study, surgical patients who did not undergo an operation exhibited a higher risk of death. Although the ICU registry does not document the reasons for these patients' lack of surgery, existing literature sheds light on this issue. For instance, a study focusing on older patients found that those who were not operated on had an increased mortality risk, particularly when the surgeon deemed the procedure too risky compared to its potential benefits [36]. Additionally, Ahmed et al. reported a preference for traditional healers over modern treatments in northern Sudan [37]. Financial constraints further complicate access to surgical care; in many low- and middle-income countries, patients often bear healthcare costs out of pocket, which can limit their ability to obtain necessary surgeries [38]. Moreover, the unavailability of qualified surgeons to perform specific procedures may contribute to the lack of surgical intervention, thereby increasing the mortality rates among these patients [39,40] It has been observed that patients requiring mechanical ventilation exhibited a significantly higher risk of mortality, specifically 56 times greater, in ICU compared to those who did not undergo mechanical ventilation. Additional studies have also indicated an increased risk of death in the intensive care setting for patients who were mechanically ventilated [18,23,30,41,42]. The underlying condition that required the patient to be placed on mechanical ventilation, along with the severity of that condition and the presence of comorbidities, has been identified as key factors contributing to the increased mortality rate [43,44]. Limitations This study, while providing valuable insights into the factors associated with mortality among surgical ICU patients in North Kivu, DRC, has several limitations that should be considered: Retrospective Design and Missing Data: The retrospective nature, combined with the absence of computerized patient tracking at the hospital, poses a risk of missing data. Notably, comorbidities, known to significantly impact ICU mortality, were not assessed due to their absence in the ICU registry. Additionally, laboratory values were not available, which could have provided crucial information on patient severity and outcomes. Lack of Traditional Scoring Systems: Unlike other studies, traditional scoring systems such as APACHE II and SOFA were not utilized. This omission is due to the lack of necessary clinical data required for calculating these scores. The absence of these standardized tools limits the study's ability to compare outcomes with other ICUs globally. Insufficient Detail on Non-Operative Management: The reasons why some patients requiring surgery did not receive it were not documented in the registry. Furthermore, the specific non-operative management strategies employed were not detailed, making it challenging to understand the full context of care decisions. No External Validation Cohort: this reduces the generalizability of the findings to other settings. This limitation underscores the need for future studies to validate these results in different contexts. Pioneering Study in the Region: Despite these limitations, this study is the first in the region to report on surgical patients in ICUs. It serves as a foundational work for future research, which could prospectively collect comprehensive data, including missing parameters such as comorbidities and detailed management strategies. Future studies should aim to address these gaps to enhance the robustness and applicability of findings. CONCLUSION This study reveals critical insights into surgical ICU mortality in North Kivu, Democratic Republic of the Congo, where 21.3% of surgical ICU patients died, with mechanical ventilation and non-operative management emerging as key factors. These findings underscore the urgent need for context-specific interventions in low-resource settings and align with global surgery priorities to reduce disparities in surgical outcomes. Abbreviations CI Confidence Interval COVID Corona Virus disease DRC Democratic Republic of the Congo ICU Intensive Care Unit IQR Interquartile Range OR Odds Ratio SD Standard Deviation SPSS Statistical Package for Social Sciences Declarations Ethics approval and consent to participate We have ensured adherence to the principles outlined in the Declaration of Helsinki [45]. The research protocol was submitted to the ethics committee of the University of Goma, to ensure compliance with ethical standards (Approval Number: UNIGOM/CEM/003/2024). Since this was a retrospective data analysis that did not involve direct contact with participants, informed consent was not obtained. Consent for publication Not applicable Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request Competing interests The authors declare that they have no competing interests Funding No funding was received for this research Authors' contributions JFB designed the study, while KMP and JFB handled data collection and statistical analysis. JFB drafted the main manuscript text, and KMC and KMJP supervised the study. All authors have read and approved the final version of the manuscript. Acknowledgements Not applicable References Berthelsen PG, Cronqvist M. The first intensive care unit in the world: Copenhagen 1953. Acta Anaesthesiol Scand. 2003;47:1190–5. Chiolero RL, Chevrolet J-C. L’unité de soins intensifs, carrefour dans l’hôpital : développer l’inter- disciplinarité et une vision de système. 2007;2819–20. Western Australians D of H. Intensive care units ( ICUs ) What is an intensive care unit ( ICU )? Pastoral care. 2024; Available from: https://www.healthywa.wa.gov.au/Articles/F_I/Intensive-care-units-ICUs OMS. Soins d ’ urgence , soins critiques et soins chirurgicaux intégrés à l ’ appui de la couverture sanitaire universelle et protection contre les urgences sanitaires 1. 2023;152:1–7. United Nation. The 2030 Agenda and the Sustainable Development Goals An opportunity for Latin America and the Caribbean [Internet]. 2018. Available from: https://repositorio.cepal.org/bitstream/handle/11362/40156/25/S1801140_en.pdf Baker T. Critical care in low-income countries. Trop Med Int Heal. 2009;14:143–8. Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, et al. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med [Internet]. 2023;49:772–84. Available from: https://doi.org/10.1007/s00134-023-07136-2 Banque Mondiale. En République démocratique du Congo , une lueur d ’ espoir en matière de soins de santé après la pandémie de Covid 19. 2023;1–6. Kalisya LM, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH. Patterns of congenital malformations and barriers to care in eastern democratic republic of congo. PLoS One. 2015;10. Coghlan B, Stewart T, Ngoy P, Mulumba F, Hardy C, Lewis J, et al. Mortality in the Democratic Republic of Congo: An ongoing crisis. Int Rescue Comm [Internet]. 2007;21. Available from: http://www.theirc.org/news/irc-study-shows-congos-neglected-crisis-leaves-54-million-dead-peace-deal-n-kivu-increased-aid--4331 Nepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A, Ademuyiwa A, et al. Global burden of postoperative death. Lancet. 2019;393:401. Rhodes A, Moreno RP, Metnitz B. Epidemiology and outcome following post-surgical admission to critical care. 2011;1466–72. Puppo Moreno AM, Abella Alvarez A, Morales Conde S, Pérez Flecha M, García Ureña M. The intensive care unit in the postoperative period of major abdominal surgery. Med Intensiva. 2019;43:569–77. Manika Muteya M et al. Epidemiological Profile of ICU Mortality at the Lubumbashi University Teaching Hospital, Democratic Republic of the Congo. Int J Sci Res. 2017;6:2029–34. Abdulla Saleh Alyamani, Salah Ahmed Binzaiad KAB. Survival Analysis And Mortality Among Patients Admitted To Surgical ICU In Ibin Sina Hospital In Mukalla City, Yemen Abdulla. Hadhramout Univ J Nat Appl Sci [Internet]. 2019;16:17–23. Available from: https://digitalcommons.aaru.edu.jo/huj_nas/vol16/iss1/2 Skinner DL, De Vasconcellos K, Wise R, Esterhuizen TM, Fourie C, Goolam Mahomed A, et al. Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study. South African Med J. 2017;107:411. Endeshaw AS, Fekede MS, Gesso AS, Aligaz EM, Aweke S. Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study. Front Med. 2023;9:1–8. Rad M. Outcomes of Surgical Patients Admitted to the Intensive Care Unit of Jimma University Medical Center. 2021;3–6. Available from: http://www.hsj.gr/ Zhang Y, Zhang J, Du Z, Ren Y, Nie J, Wu Z, et al. Risk factors for 28-day mortality in a surgical ICU: A retrospective analysis of 347 cases. Risk Manag Healthc Policy. 2021;14:1555–62. Ahmed S, Yusuf OF, Alam AS, Awal A. Profile of Intensive Care Unit admission and Outcomes of Medical and Surgical patients at A Tertiary Government Hospital: A 5 Year Trend Analysis. Bangladesh J Med. 2018;29:59–62. Khanduri S, Katiyar S, Kishore N, Sodhi R, Aggarwal A. Retrospective review of profile of intensive care unit admissions and outcomes in a tertiary care hospital of Himalayan region. Int J Res Med Sci. 2017;5:4715. Karlović Z, Perić M, Vladić D, Kosjerina A, Majerić-Kogler V. The significance of demographic factors (age, sex, preoperative physiological status) and type of surgery on patients’ outcome in ICU. Signa Vitae. 2013;8:42–8. Abebe K, Negasa T, Argaw F. Surgical Admissions and Treatment Outcomes at a Tertiary Hospital Intensive Care Unit in Ethiopia: A Two-Year Review. Ethiop J Health Sci. 2020;30:725–32. Vezzani A, Mergoni M, Orlandi P, Corradi F, Volpi A, Zasa M. Gender Differences in Case Mix and Outcome of Critically Ill Patients. GENM [Internet]. 2011;8:32–9. Available from: http://dx.doi.org/10.1016/j.genm.2010.11.011 Patel S, Kacheriwala S, Duttaroy Di. Audit of postoperative surgical intensive care unit admissions. Indian J Crit Care Med. 2018;22:10–5. Lat TI, Mcgraw MK, White HD. Gender differences in critical illness and critical care research. 2020; Vargas N, Tibullo L, Landi E, Carifi G, Pirone A, Pippo A, et al. Caring for critically ill oldest old patients: a clinical review. Aging Clin Exp Res. 2017;29:833–45. Level C, Tellier E, Dezou P, Chaoui K, Kherchache A, Sejourné P, et al. Outcome of older persons admitted to intensive care unit, mortality, prognosis factors, dependency scores and ability trajectory within 1 year: a prospective cohort study. Aging Clin Exp Res [Internet]. 2018;30:1041–51. Available from: http://dx.doi.org/10.1007/s40520-017-0871-z Populationof.net. Population of Democratic Republic of the Congo. 2024 demographics: density, ratios, growth rate, clock, rate of men to women. 2024; Available from: https://www.populationof.net/democratic-republic-of-the-congo/ Zewudie MM, Melesse DY, Filatie TD, Zeleke ME. Variables associated to intensive care unit (ICU)-mortality among patients admitted to surgical intensive care unit in Ethiopia: a retrospective observational study. BMC Anesthesiol. 2023;23:1–9. Soares D, Sultan R, Shahzad N, Zafar H. Morbidity and Mortality in the Surgical ICU: A Retrospective Audit in a Tertiary Care Center of a Developing Country. Med Clin Res. 2017;2:1–5. Wondimu S, Bekele S, Giorgis DG, Getachew F, Seyoum N. Pattern of surgical admissions to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A five-year retrospective study. East Cent African J Surg. 2018;23:66–70. Mamo D, Aklog E, Gebremedhin Y. Patterns of admission and outcome of patients admitted to the intensive care unit of Addis Ababa Burn Emergency and Trauma Hospital. Sci Rep [Internet]. 2023;13:1–10. Available from: https://doi.org/10.1038/s41598-023-33437-z Chalya PL, Gilyoma JM, Dass RM, Mchembe MD, Matasha M, Mabula JB, et al. Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med [Internet]. 2011;19:61. Available from: http://www.sjtrem.com/content/19/1/61 Sudarshan M, Feldman LS, St. Louis E, Al-Habboubi M, Elhusseini Hassan MM, Fata P, et al. Predictors of mortality and morbidity for acute care surgery patients. J Surg Res. 2015;193:868–73. Deverakonda DL, Kishawi SK, Lapinski MF, Adomshick VJ, Siff JE, Brown LR, et al. What if we do not Operate? Outcomes of Nonoperatively Managed Emergency General Surgery Patients. J Surg Res [Internet]. 2023;284:29–36. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9911375/pdf/nihms-1863642.pdf Ahmed GEM, Ahmed EYM, Ahmed AE, Hemmeda L, Birier AB, Abdelgadir T, et al. Prevalence and reasons to seek traditional healing methods among residents of two localities in North Kordofan State, Sudan 2022: A cross-sectional study. Heal Sci Reports [Internet]. 2023;6:1–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10444970/pdf/HSR2-6-e1487.pdf Bolongaita S, Lee Y, Johansson KA, Haaland ØA, Tolla MT, Lee J, et al. Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study. BMC Med [Internet]. 2023;21:1–13. Available from: https://doi.org/10.1186/s12916-023-02957-w Ologunde R, Maruthappu M, Shanmugarajah K, Shalhoub J. Surgical care in low and middle-income countries: Burden and barriers. Int J Surg [Internet]. 2014;12:858–63. Available from: http://dx.doi.org/10.1016/j.ijsu.2014.07.009 Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569–624. Carlos Junior T, Franca SA, Okamoto VN, Salge JM, Carvalho CRR. Infection as an independent risk factor for mortality in the surgical intensive care unit. Clinics. 2013;68:1103–8. Nantulu C, Makulo J-R, Lepira FB, Shamamba R, Nlandu YM, Amisi EB, et al. 3-Survie-et-predicteurs-de-la-mortalite-des-patients-admis-au-Service-de-Reanimation-polyvalente-compresse.pdf. Ann Africaines Médecine. 2021; Abate SM, Basu B, Jemal B, Ahmed S, Mantefardo B, Taye T. Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis. Crit Care [Internet]. 2023;27:1–13. Available from: https://doi.org/10.1186/s13054-023-04316-w Alamaw AW, Abebe GK, Abate BB, Tilahun BD, Yilak G, Birara WA, et al. Mortality and associated factors among intensive care unit admitted adult patients with mechanical ventilation in ethiopia: A systematic review and meta-analysis. Shock [Internet]. 2024;61:660–5. Available from: https://journals.lww.com/shockjournal/abstract/2024/05000/mortality_and_associated_factors_among_intensive.3.aspx The World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. 2008;1–5. Available from: https://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2008.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Jul, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 02 Jun, 2025 Reviews received at journal 01 Jun, 2025 Reviews received at journal 27 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers agreed at journal 17 May, 2025 Reviews received at journal 16 May, 2025 Reviewers agreed at journal 16 May, 2025 Reviewers invited by journal 15 May, 2025 Editor assigned by journal 15 May, 2025 Submission checks completed at journal 27 Mar, 2025 First submitted to journal 24 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5968698","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458112974,"identity":"7cc8872c-3c3f-4248-b7b6-7d0cd439f0c8","order_by":0,"name":"Jacques Fadhili Bake","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBAC9gYGM4aEAokEBh4GxgdAAR4+Qlp4DoC0GIC1MBuABNiI0sJgwADSwiYBEiGshf3wtgcPDCzy+HsOH6v8mmMnw8bA/PDRDXxaeNLKDYAOK5Y425Z2W3ZbMtBhbMbGOXi02DPkmEkAtSQ2nOcxuy25jRmohYdNGp8WHv43EC3zz/N/K5bcVk+EFgmoLRvO9rAxftx2mBgtz8pAWooNzxwzlmbcdpyHjZmAX3j4k7dJ/qioy5M7k/zw489t1fb87M0PH+PTggKYecAkscpBgPEHKapHwSgYBaNgxAAAWOdBvJwk/DoAAAAASUVORK5CYII=","orcid":"","institution":"HEAL AFRICA Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jacques","middleName":"Fadhili","lastName":"Bake","suffix":""},{"id":458112975,"identity":"fd928c93-c055-4e04-9e36-1173f0bb8974","order_by":1,"name":"Kambere Mukama Phalek","email":"","orcid":"","institution":"HEAL AFRICA Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kambere","middleName":"Mukama","lastName":"Phalek","suffix":""},{"id":458112976,"identity":"051598cb-5130-4107-ae1f-5373a691c0ef","order_by":2,"name":"Mumbere Kigayi Jean-Pierre","email":"","orcid":"","institution":"HEAL AFRICA Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mumbere","middleName":"Kigayi","lastName":"Jean-Pierre","suffix":""},{"id":458112977,"identity":"2b00acca-2055-4e19-8a7f-01c3b831345d","order_by":3,"name":"Kasereka Masumbuko Claude","email":"","orcid":"","institution":"Catholic University of Graben","correspondingAuthor":false,"prefix":"","firstName":"Kasereka","middleName":"Masumbuko","lastName":"Claude","suffix":""}],"badges":[],"createdAt":"2025-02-05 22:09:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5968698/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5968698/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-025-03031-3","type":"published","date":"2025-07-03T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":86179138,"identity":"3ed072df-ea4f-4a3c-b0db-7d9552598b5f","added_by":"auto","created_at":"2025-07-07 16:16:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":648665,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5968698/v1/c1495a08-a602-4832-9280-7912fac2c520.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors Associated with Mortality in Surgical Patients Admitted to a Low-Resource Mixed Intensive Care Unit: A Cross-Sectional Study","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eThe Intensive Care Unit (ICU) is a specialized department where critically ill patients receive continuous monitoring and treatment around the clock. Its primary objective is to restore and sustain the function of vital organs, thereby enhancing the likelihood of survival. This unit is regarded as a central hub, capable of accommodating patients from various medical specialties. [1\u0026ndash;3].\u003c/p\u003e \u003cp\u003eTo ensure the provision of high-quality primary healthcare, it is crucial to integrate emergency services, critical care, and surgical care [4]. An effectively organized system of these services is crucial for achieving the diverse objectives linked to the third Sustainable Development Goal, which seeks to ensure healthy lives and promote well-being for everyone, particularly in relation to universal health coverage [4,5]. Most healthcare facilities in sub-Saharan Africa lack intensive care services, and when such services are available, they are often quite rudimentary [6,7].\u003c/p\u003e \u003cp\u003eThe Coronavirus disease (COVID)-19 health crisis has highlighted significant deficiencies in emergency services, critical care, and surgical care, resulting in considerable avoidable mortality and morbidity on a global scale. In March 2020, the DRC faced the dual challenges of the COVID-19 pandemic and an Ebola outbreak. These concurrent crises exposed a stark lack of essential resources within healthcare facilities, particularly regarding equipment necessary for intensive care [4,8].\u003c/p\u003e \u003cp\u003eIn addition to these health crises, the DRC, particularly the North Kivu province, has faced significant health challenges due to armed conflicts, natural disasters, and limited healthcare infrastructure [9,10].\u003c/p\u003e \u003cp\u003eStatistical data indicate that at least 4.2\u0026nbsp;million individuals die each year within 30 days following a surgical procedure globally, with half of these fatalities occurring in low- or middle-income countries [11]. In numerous circumstances, patients, their relatives, and even healthcare professionals frequently place significant emphasis on the technical aspects of a surgical procedure. However, it is essential to highlight that establishing an optimal perioperative practice is equally critical as the specific technical issues encountered in the surgical field during the execution of the surgical intervention [12,13].\u003c/p\u003e \u003cp\u003eThere is a lack of data regarding the mortality of surgical patients admitted to intensive care units in the North Kivu, a province of eastern DRC, particularly in Goma, the provincial capital. A study aimed at collecting and analyzing information on the factors associated with the mortality of surgical patients in intensive care could address this gap. Understanding these factors could enhance health service planning, resource allocation, and the development of treatment protocols tailored to local needs.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eStudy area and period\u003c/p\u003e \u003cp\u003eThis study was conducted at HEAL Africa Hospital, a university hospital located in Goma, the capital of the North Kivu province in the eastern part of the DRC, during the period from January 1, 2021, to June 30, 2023. It is equipped with 260 beds, which include 6 beds designated for the adult and children intensive care unit, neonate requiring intensive care have their separate units in the neonatal department. This is a mixed intensive care unit accommodating patients from all departments requiring intensive care. In terms of essential equipment, there are four functional ventilators in the intensive care unit, along with wall-mounted oxygen, oxygen cylinders, and oxygen concentrators available as needed. Multiparameter monitors are also present and mounted on the walls next to each bed.\u003c/p\u003e \u003cp\u003ePopulation and sampling\u003c/p\u003e \u003cp\u003eIn the context of this research, a comprehensive sampling of all surgical patients admitted to the intensive care unit at HEAL Africa Hospital was conducted. The inclusion criteria encompassed patients of all ages and sex with various general surgical conditions admitted to the intensive care unit during the study period. Conversely, the exclusion criteria consisted of female patients who underwent surgery for gynecological or obstetrical issues, as well as patients whose critical data were missing.\u003c/p\u003e \u003cp\u003eTypes of study and data collection and analysis\u003c/p\u003e \u003cp\u003eThis is a retrospective cross-sectional study.\u003c/p\u003e \u003cp\u003eData were obtained from the admission and discharge registry of patients admitted to the ICU, facilitating the inclusion of demographic information such as age, sex, originating department, relevant subspecialty, diagnosis, received treatment, types of operations performed, mechanical ventilation use, length of stay in the ICU, and mortality rates. The ICU registry is under the oversight of the head nurse of the ICU, who serves as the primary authority responsible for ensuring data quality. He ensures that the data captured in the registry is accurate and reliable.\u003c/p\u003e \u003cp\u003eAll of this information was directly entered into Excel software to prepare it for statistical analysis using Statistical Package for Social Sciences (SPSS) 26 [IBM, Armonk, NY] for Windows. Logistic regression was chosen as the outcome variable (ICU mortality) is binary (alive/dead).\u003c/p\u003e \u003cp\u003eVariables\u003c/p\u003e \u003cp\u003eDependent Variable\u003c/p\u003e \u003cp\u003eICU mortality: Binary (1\u0026thinsp;=\u0026thinsp;death, 0\u0026thinsp;=\u0026thinsp;survival).\u003c/p\u003e \u003cp\u003eIndependent Variables\u003c/p\u003e \u003cp\u003eVariables were selected based on clinical relevance and availability in the ICU registry:\u003c/p\u003e \u003cp\u003eDemographics: Age, sex, originating department.\u003c/p\u003e \u003cp\u003eClinical and management factors: Diagnosis, Subspeciality, Need for mechanical ventilation (binary: yes/no), 0perative management (binary: surgical vs. non-surgical), Type of surgery.\u003c/p\u003e \u003cp\u003eOperational factors: Length of ICU stay, reason for admission.\u003c/p\u003e \u003cp\u003eUnivariate Analysis: Each variable was tested individually for association with mortality using univariate logistic regression.\u003c/p\u003e \u003cp\u003eMultivariate Analysis: Variables with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in univariate analysis were included in a multivariable logistic regression model to adjust for confounding.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eFrom January 1, 2021, to June 30, 2023, a total of 807 critically ill patients were admitted to the mixed intensive care unit at HEAL Africa Hospital. Of these, 368 patients (43.12%) were surgical cases, originating from the operating room, emergency department, and general hospitalization. However, 20 patients were excluded from the analysis due to missing data. Among the 348 participants included in this study, 74 individuals (21.26%) had succumbed to their conditions.\u003c/p\u003e \u003cp\u003eDemographic characteristics and mortality\u003c/p\u003e \u003cp\u003eThe majority of patients admitted to intensive care were male, comprising 217 individuals (62.4%), resulting in a male-to-female ratio of 1.6:1. The median age of the participants was 31 years, with an interquartile range of 20 to 46 years. Ages among the patients varied from 1 year to 85 years. A significant proportion of patients (69.3%) were admitted from the operating room (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of patients and mortality rates.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e348 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e74 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e274 (78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e131 (37.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e17 (13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e114 (87.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e217 (62.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e160 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.4 (1.3\u0026ndash;4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e33 (20\u0026ndash;46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e35 (23\u0026ndash;47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31 (18\u0026ndash;45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOriginating department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOperating room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e241 (69.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e213 (88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1,0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEmergency room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e94 (27.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e41 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e53 (56.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.8 (3.2\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e13 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (38.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (61.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.7 (1.1\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eSD: Standard deviation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA statistically significant association was noted between patient sex and mortality, with males exhibiting a higher risk of death in the intensive care unit compared to females (odds ratio (OR): 2.4, 95% confidence interval (CI): 1.3\u0026ndash;4.3, p\u0026thinsp;=\u0026thinsp;0.004). Additionally, a statistically significant relationship was observed between the source of patient admission and mortality. Patients admitted from the emergency department (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) and those from inpatient wards (p\u0026thinsp;=\u0026thinsp;0.02) had a higher OR of mortality in the ICU compared to those admitted from the operating room (see Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClinical Features and Mortality Rates\u003c/p\u003e \u003cp\u003eA significant proportion of patients (54.6%) were sourced from the general surgery subspecialty. The predominant cause for admission to the ICU was postoperative monitoring, which was noted in 57.2% of patients (see table 2).\u003c/p\u003e \u003cp\u003eTableau 2. Clinical characteristics and mortality\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e274(78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0 (0.000-.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCleft lip and palate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0 (0.000-.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow limb gangrene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.899E-8 (3.557E-9-1.014E-7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGI bleeding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2.725E-17 (0.000-.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.997\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePancreatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.519E-8(2.690E-9-8.584E-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBowel obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (5.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17 (89.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e6.458E-8 (1.434E-8-2.908E-7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColorectal conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (3.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0 (0.000-.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrain abscess\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.140E-8 (1.843E-9-7.045E-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSkin and subcutaneous conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0 (0.000-.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper airways obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e2.659E-8 (5.324E-9-1.328E-7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGastroduodenal ulcer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 62.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.266E-8 (2.906E-9-5.517E-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-traumatic Orthopedic conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (6.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (93.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.140E-7 (1.463E-8-8.879E-7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGoiter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0 (0.000-.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeritonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55 (15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e44 (80.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e3.039E-8 (1.444E-8-6.396E-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e160 (46.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e114 (71.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.883E-8 (1.883E-8-1.883E-8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIatrogenic ureteric injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubspeciality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeneral surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190 (54.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42 (30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e148 (70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51 (65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.9 (1.0-3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthopedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (14.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (7.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (92.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.3(0.1\u0026ndash;0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePlastic surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason of\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eadmission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePost op monitoring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e199(57.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e183 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolytrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (23.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31 (38.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e49 (61.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e7.2(3.5\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere sepsis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (29.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(70.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e4.8 (1.9\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.0003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11 (52.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e10 (3.3\u0026ndash;31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHemorrhagic shock\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eIQR: Interquartile range\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eA statistically significant relationship is identified between the admission diagnosis (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), surgical subspecialty (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), the reason for intensive care admission (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001), and mortality outcomes (see table 2).\u003c/p\u003e \u003cp\u003eTherapeutic factors and mortality\u003c/p\u003e \u003cp\u003eA significant proportion of patients admitted to the ICU had undergone surgical procedures, accounting for 80.7% of the total population, while 19.3% received conservative treatment. In total, 58 patients required mechanical ventilation, representing 16.7% of the overall population (see table 3).\u003c/p\u003e \u003cp\u003eTableau 3. Therapeutic factors and mortality\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003cp\u003e(95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e348 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e274 (78.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290 (83.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e265 (91.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (84.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56 (24\u0026ndash;147)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emanagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e281(80.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40 (14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e241(85.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConservative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (19.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34 (50.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (49.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.2 (3.3\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe odds of mortality in ICU were found to be 56 times greater for patients who were placed on ventilators (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Additionally, it was observed that surgical patients who did not undergo any surgical procedures had an OR of 6.2 for mortality in intensive care compared to those who did undergo surgery (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (see table 3).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study primarily aimed to identify the factors associated with mortality among patients with surgical conditions admitted to the ICU of HEAL Africa Hospital. More specifically, we sought to determine the demographic, clinical, and therapeutic characteristics linked to the mortality of these patients.\u003c/p\u003e \u003cp\u003eThis study revealed a mortality rate of 21.26% among surgical patients admitted to intensive care. This figure is comparable to those observed in Lubumbashi (19.8%), Yemen (20%), and South Africa (22.4%) [14\u0026ndash;16]. On the other hand, it is lower than the mortality rates reported by Endeshaw et al. (45%) in Ethiopia, Rad (39.8%) in Ethiopia, Zhang et al. (32.6%) in China, and Ahmed et al. (51%) in Bangladesh [17\u0026ndash;20]. The observed difference can be attributed to the specific characteristics of the studied population. Our analysis indicates that a significant proportion of patients admitted to the ICU were actually in a phase of postoperative monitoring. This postoperative observation is influenced not only by the complexity of the surgical procedures undergone by the patients but also by organizational constraints, such as a reduced availability of nursing staff in the recovery room for surgeries conducted later in the day. This practice contrasts with that seen in many other intensive care units, where admissions are more closely associated with the severity of the patients' illnesses or the complexity of the surgeries performed [21\u0026ndash;23].\u003c/p\u003e \u003cp\u003eDemographic characteristics and mortality\u003c/p\u003e \u003cp\u003eOur study indicates a significantly higher mortality rate among men, with a p-value of 0.004. However, numerous previous studies have not demonstrated any significant variation in mortality rates [16,19,24,25]. The observed differences within our study population can be ascribed to the varying pathologies identified in males and females. Males are more frequently affected by polytrauma and neurosurgical conditions. Furthermore, hormonal disparities between male and female individuals may impact the body's response to severe illness and affect recovery rates. For instance, it is hypothesized that the estrogen present in females exerts positive effects on cardiovascular health and immune response [26].\u003c/p\u003e \u003cp\u003eIt has been observed that age does not play a significant role in mortality (p\u0026thinsp;=\u0026thinsp;0.07). This finding aligns with the results of several other studies that have similarly demonstrated the lack of influence of age on mortality [19,22,23,25]. However, further research has highlighted a high mortality rate among older individuals. Indeed, the literature links an age greater than 65 years to various comorbidities, including cardiovascular, pulmonary, metabolic, and neurological diseases. Additionally, their immune system may be compromised, resulting in a less effective inflammatory response during stressful situations such as surgery. This stress increases the risk of severe complications and mortality [27,28]. Our findings can be attributed to the demographic composition of our study population, which predominantly consisted of younger individuals. The age distribution within the Congolese population reveals that approximately 55.7% of individuals are 19 years old or younger, 41.2% fall within the age range of 20 to 64 years, and merely 3.1% are aged 65 years or older [29].\u003c/p\u003e \u003cp\u003eIn the course of this research, it was noted that the majority of surgical patients admitted to the ICU originated from the operating room. Patients arriving from the emergency department exhibited a significantly higher risk of mortality compared to those coming from inpatient wards or the operating room (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). These findings contrast with those reported by other authors, who observed that most patients admitted to ICU were sourced from emergency services [23,30,31]. In addition to the previously mentioned reasons, it is crucial to emphasize that patients arriving from emergency services who require surgical intervention are primarily directed to the operating room. This categorizes them more as operating room patients rather than emergency patients. Consequently, this practice diminishes the number of admissions from emergency services for our study.\u003c/p\u003e \u003cp\u003eClinical characteristics and mortality\u003c/p\u003e \u003cp\u003eThe findings of this study suggest that patients within the field of neurosurgery exhibit a higher mortality rate compared to those from other specialties. This observation aligns with the results of a previous study conducted in Ethiopia [32]. This situation can be attributed to the fact that the majority of our patients admitted for neurosurgical conditions experience severe head trauma, which are linked to a high risk of mortality in intensive care, as highlighted by several authors [17,30,33,34].\u003c/p\u003e \u003cp\u003eThe primary reason for admission to ICU was postoperative monitoring, a finding that aligns with the results of Endeshaw et al. in Ethiopia, who also noted this trend [17]. Numerous other authors have recognized various diagnostic categories as reasons for admission [23,31,35]. There is also no association whatsoever between mortality and the reason for admission to the intensive care unit. [23]. This situation can be attributed to the disparities in the studied population and the criteria for admission to ICU, which differ from one institution to another. For instance, in our study, the lack of a nurse for the postoperative monitoring of patients who underwent surgery late in the day may lead to the admission of a patient to the ICU without any other justification for such admission.\u003c/p\u003e \u003cp\u003eThe findings of this study indicated that there was no statistically significant impact of the length of stay in the ICU on mortality rates. These conclusions contradict the results reported by other researchers who found a significant relationship between length of stay and mortality [23,25]. According to these authors, an extended stay is a factor that increases mortality in ICU. In our study, the lack of a significant impact of length of stay on mortality may be attributed to the average short duration of 2 days that our patients spent in intensive care. This is further elucidated by the observation that most of our patients were admitted for postoperative monitoring.\u003c/p\u003e \u003cp\u003eTherapeutic factors and mortality\u003c/p\u003e \u003cp\u003eIn this study, surgical patients who did not undergo an operation exhibited a higher risk of death. Although the ICU registry does not document the reasons for these patients' lack of surgery, existing literature sheds light on this issue. For instance, a study focusing on older patients found that those who were not operated on had an increased mortality risk, particularly when the surgeon deemed the procedure too risky compared to its potential benefits [36]. Additionally, Ahmed et al. reported a preference for traditional healers over modern treatments in northern Sudan [37]. Financial constraints further complicate access to surgical care; in many low- and middle-income countries, patients often bear healthcare costs out of pocket, which can limit their ability to obtain necessary surgeries [38]. Moreover, the unavailability of qualified surgeons to perform specific procedures may contribute to the lack of surgical intervention, thereby increasing the mortality rates among these patients [39,40]\u003c/p\u003e \u003cp\u003eIt has been observed that patients requiring mechanical ventilation exhibited a significantly higher risk of mortality, specifically 56 times greater, in ICU compared to those who did not undergo mechanical ventilation. Additional studies have also indicated an increased risk of death in the intensive care setting for patients who were mechanically ventilated [18,23,30,41,42]. The underlying condition that required the patient to be placed on mechanical ventilation, along with the severity of that condition and the presence of comorbidities, has been identified as key factors contributing to the increased mortality rate [43,44].\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThis study, while providing valuable insights into the factors associated with mortality among surgical ICU patients in North Kivu, DRC, has several limitations that should be considered:\u003c/p\u003e \u003cp\u003eRetrospective Design and Missing Data: The retrospective nature, combined with the absence of computerized patient tracking at the hospital, poses a risk of missing data. Notably, comorbidities, known to significantly impact ICU mortality, were not assessed due to their absence in the ICU registry. Additionally, laboratory values were not available, which could have provided crucial information on patient severity and outcomes.\u003c/p\u003e \u003cp\u003eLack of Traditional Scoring Systems: Unlike other studies, traditional scoring systems such as APACHE II and SOFA were not utilized. This omission is due to the lack of necessary clinical data required for calculating these scores. The absence of these standardized tools limits the study's ability to compare outcomes with other ICUs globally.\u003c/p\u003e \u003cp\u003eInsufficient Detail on Non-Operative Management: The reasons why some patients requiring surgery did not receive it were not documented in the registry. Furthermore, the specific non-operative management strategies employed were not detailed, making it challenging to understand the full context of care decisions.\u003c/p\u003e \u003cp\u003eNo External Validation Cohort: this reduces the generalizability of the findings to other settings. This limitation underscores the need for future studies to validate these results in different contexts.\u003c/p\u003e \u003cp\u003ePioneering Study in the Region: Despite these limitations, this study is the first in the region to report on surgical patients in ICUs. It serves as a foundational work for future research, which could prospectively collect comprehensive data, including missing parameters such as comorbidities and detailed management strategies. Future studies should aim to address these gaps to enhance the robustness and applicability of findings.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study reveals critical insights into surgical ICU mortality in North Kivu, Democratic Republic of the Congo, where 21.3% of surgical ICU patients died, with mechanical ventilation and non-operative management emerging as key factors. These findings underscore the urgent need for context-specific interventions in low-resource settings and align with global surgery priorities to reduce disparities in surgical outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOVID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCorona Virus disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInterquartile Range\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOdds Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eWe have ensured adherence to the principles outlined in the Declaration of Helsinki [45]. The research protocol was submitted to the ethics committee of the University of Goma, to ensure compliance with ethical standards (Approval Number: UNIGOM/CEM/003/2024). Since this was a retrospective data analysis that did not involve direct contact with participants, informed consent was not obtained.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funding was received for this research\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eJFB designed the study, while KMP and JFB handled data collection and statistical analysis. JFB drafted the main manuscript text, and KMC and KMJP supervised the study. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBerthelsen PG, Cronqvist M. The first intensive care unit in the world: Copenhagen 1953. Acta Anaesthesiol Scand. 2003;47:1190\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eChiolero RL, Chevrolet J-C. L\u0026rsquo;unit\u0026eacute; de soins intensifs, carrefour dans l\u0026rsquo;h\u0026ocirc;pital : d\u0026eacute;velopper l\u0026rsquo;inter- disciplinarit\u0026eacute; et une vision de syst\u0026egrave;me. 2007;2819\u0026ndash;20. \u003c/li\u003e\n\u003cli\u003eWestern Australians D of H. Intensive care units ( ICUs ) What is an intensive care unit ( ICU )? Pastoral care. 2024; Available from: https://www.healthywa.wa.gov.au/Articles/F_I/Intensive-care-units-ICUs\u003c/li\u003e\n\u003cli\u003eOMS. Soins d \u0026rsquo; urgence , soins critiques et soins chirurgicaux int\u0026eacute;gr\u0026eacute;s \u0026agrave; l \u0026rsquo; appui de la couverture sanitaire universelle et protection contre les urgences sanitaires 1. 2023;152:1\u0026ndash;7. \u003c/li\u003e\n\u003cli\u003eUnited Nation. The 2030 Agenda and the Sustainable Development Goals An opportunity for Latin America and the Caribbean [Internet]. 2018. Available from: https://repositorio.cepal.org/bitstream/handle/11362/40156/25/S1801140_en.pdf\u003c/li\u003e\n\u003cli\u003eBaker T. Critical care in low-income countries. Trop Med Int Heal. 2009;14:143\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSpencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D, et al. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med [Internet]. 2023;49:772\u0026ndash;84. Available from: https://doi.org/10.1007/s00134-023-07136-2\u003c/li\u003e\n\u003cli\u003eBanque Mondiale. En R\u0026eacute;publique d\u0026eacute;mocratique du Congo , une lueur d \u0026rsquo; espoir en mati\u0026egrave;re de soins de sant\u0026eacute; apr\u0026egrave;s la pand\u0026eacute;mie de Covid 19. 2023;1\u0026ndash;6. \u003c/li\u003e\n\u003cli\u003eKalisya LM, Nyavandu K, Machumu B, Kwiratuwe S, Rej PH. Patterns of congenital malformations and barriers to care in eastern democratic republic of congo. PLoS One. 2015;10. \u003c/li\u003e\n\u003cli\u003eCoghlan B, Stewart T, Ngoy P, Mulumba F, Hardy C, Lewis J, et al. Mortality in the Democratic Republic of Congo: An ongoing crisis. Int Rescue Comm [Internet]. 2007;21. Available from: http://www.theirc.org/news/irc-study-shows-congos-neglected-crisis-leaves-54-million-dead-peace-deal-n-kivu-increased-aid--4331\u003c/li\u003e\n\u003cli\u003eNepogodiev D, Martin J, Biccard B, Makupe A, Bhangu A, Ademuyiwa A, et al. Global burden of postoperative death. Lancet. 2019;393:401. \u003c/li\u003e\n\u003cli\u003eRhodes A, Moreno RP, Metnitz B. Epidemiology and outcome following post-surgical admission to critical care. 2011;1466\u0026ndash;72. \u003c/li\u003e\n\u003cli\u003ePuppo Moreno AM, Abella Alvarez A, Morales Conde S, P\u0026eacute;rez Flecha M, Garc\u0026iacute;a Ure\u0026ntilde;a M. The intensive care unit in the postoperative period of major abdominal surgery. Med Intensiva. 2019;43:569\u0026ndash;77. \u003c/li\u003e\n\u003cli\u003eManika Muteya M et al. Epidemiological Profile of ICU Mortality at the Lubumbashi University Teaching Hospital, Democratic Republic of the Congo. Int J Sci Res. 2017;6:2029\u0026ndash;34. \u003c/li\u003e\n\u003cli\u003eAbdulla Saleh Alyamani, Salah Ahmed Binzaiad KAB. Survival Analysis And Mortality Among Patients Admitted To Surgical ICU In Ibin Sina Hospital In Mukalla City, Yemen Abdulla. Hadhramout Univ J Nat Appl Sci [Internet]. 2019;16:17\u0026ndash;23. Available from: https://digitalcommons.aaru.edu.jo/huj_nas/vol16/iss1/2\u003c/li\u003e\n\u003cli\u003eSkinner DL, De Vasconcellos K, Wise R, Esterhuizen TM, Fourie C, Goolam Mahomed A, et al. Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study. South African Med J. 2017;107:411. \u003c/li\u003e\n\u003cli\u003eEndeshaw AS, Fekede MS, Gesso AS, Aligaz EM, Aweke S. Survival status and predictors of mortality among patients admitted to surgical intensive care units of Addis Ababa governmental hospitals, Ethiopia: A multicenter retrospective cohort study. Front Med. 2023;9:1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eRad M. Outcomes of Surgical Patients Admitted to the Intensive Care Unit of Jimma University Medical Center. 2021;3\u0026ndash;6. Available from: http://www.hsj.gr/\u003c/li\u003e\n\u003cli\u003eZhang Y, Zhang J, Du Z, Ren Y, Nie J, Wu Z, et al. Risk factors for 28-day mortality in a surgical ICU: A retrospective analysis of 347 cases. Risk Manag Healthc Policy. 2021;14:1555\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eAhmed S, Yusuf OF, Alam AS, Awal A. Profile of Intensive Care Unit admission and Outcomes of Medical and Surgical patients at A Tertiary Government Hospital: A 5 Year Trend Analysis. Bangladesh J Med. 2018;29:59\u0026ndash;62. \u003c/li\u003e\n\u003cli\u003eKhanduri S, Katiyar S, Kishore N, Sodhi R, Aggarwal A. Retrospective review of profile of intensive care unit admissions and outcomes in a tertiary care hospital of Himalayan region. Int J Res Med Sci. 2017;5:4715. \u003c/li\u003e\n\u003cli\u003eKarlović Z, Perić M, Vladić D, Kosjerina A, Majerić-Kogler V. The significance of demographic factors (age, sex, preoperative physiological status) and type of surgery on patients\u0026rsquo; outcome in ICU. Signa Vitae. 2013;8:42\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eAbebe K, Negasa T, Argaw F. Surgical Admissions and Treatment Outcomes at a Tertiary Hospital Intensive Care Unit in Ethiopia: A Two-Year Review. Ethiop J Health Sci. 2020;30:725\u0026ndash;32. \u003c/li\u003e\n\u003cli\u003eVezzani A, Mergoni M, Orlandi P, Corradi F, Volpi A, Zasa M. Gender Differences in Case Mix and Outcome of Critically Ill Patients. GENM [Internet]. 2011;8:32\u0026ndash;9. Available from: http://dx.doi.org/10.1016/j.genm.2010.11.011\u003c/li\u003e\n\u003cli\u003ePatel S, Kacheriwala S, Duttaroy Di. Audit of postoperative surgical intensive care unit admissions. Indian J Crit Care Med. 2018;22:10\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eLat TI, Mcgraw MK, White HD. Gender differences in critical illness and critical care research. 2020; \u003c/li\u003e\n\u003cli\u003eVargas N, Tibullo L, Landi E, Carifi G, Pirone A, Pippo A, et al. Caring for critically ill oldest old patients: a clinical review. Aging Clin Exp Res. 2017;29:833\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eLevel C, Tellier E, Dezou P, Chaoui K, Kherchache A, Sejourn\u0026eacute; P, et al. Outcome of older persons admitted to intensive care unit, mortality, prognosis factors, dependency scores and ability trajectory within 1 year: a prospective cohort study. Aging Clin Exp Res [Internet]. 2018;30:1041\u0026ndash;51. Available from: http://dx.doi.org/10.1007/s40520-017-0871-z\u003c/li\u003e\n\u003cli\u003ePopulationof.net. Population of Democratic Republic of the Congo. 2024 demographics: density, ratios, growth rate, clock, rate of men to women. 2024; Available from: https://www.populationof.net/democratic-republic-of-the-congo/\u003c/li\u003e\n\u003cli\u003eZewudie MM, Melesse DY, Filatie TD, Zeleke ME. Variables associated to intensive care unit (ICU)-mortality among patients admitted to surgical intensive care unit in Ethiopia: a retrospective observational study. BMC Anesthesiol. 2023;23:1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSoares D, Sultan R, Shahzad N, Zafar H. Morbidity and Mortality in the Surgical ICU: A Retrospective Audit in a Tertiary Care Center of a Developing Country. Med Clin Res. 2017;2:1\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eWondimu S, Bekele S, Giorgis DG, Getachew F, Seyoum N. Pattern of surgical admissions to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: A five-year retrospective study. East Cent African J Surg. 2018;23:66\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eMamo D, Aklog E, Gebremedhin Y. Patterns of admission and outcome of patients admitted to the intensive care unit of Addis Ababa Burn Emergency and Trauma Hospital. Sci Rep [Internet]. 2023;13:1\u0026ndash;10. Available from: https://doi.org/10.1038/s41598-023-33437-z\u003c/li\u003e\n\u003cli\u003eChalya PL, Gilyoma JM, Dass RM, Mchembe MD, Matasha M, Mabula JB, et al. Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med [Internet]. 2011;19:61. Available from: http://www.sjtrem.com/content/19/1/61\u003c/li\u003e\n\u003cli\u003eSudarshan M, Feldman LS, St. Louis E, Al-Habboubi M, Elhusseini Hassan MM, Fata P, et al. Predictors of mortality and morbidity for acute care surgery patients. J Surg Res. 2015;193:868\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eDeverakonda DL, Kishawi SK, Lapinski MF, Adomshick VJ, Siff JE, Brown LR, et al. What if we do not Operate? Outcomes of Nonoperatively Managed Emergency General Surgery Patients. J Surg Res [Internet]. 2023;284:29\u0026ndash;36. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9911375/pdf/nihms-1863642.pdf\u003c/li\u003e\n\u003cli\u003eAhmed GEM, Ahmed EYM, Ahmed AE, Hemmeda L, Birier AB, Abdelgadir T, et al. Prevalence and reasons to seek traditional healing methods among residents of two localities in North Kordofan State, Sudan 2022: A cross-sectional study. Heal Sci Reports [Internet]. 2023;6:1\u0026ndash;8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10444970/pdf/HSR2-6-e1487.pdf\u003c/li\u003e\n\u003cli\u003eBolongaita S, Lee Y, Johansson KA, Haaland \u0026Oslash;A, Tolla MT, Lee J, et al. Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study. BMC Med [Internet]. 2023;21:1\u0026ndash;13. Available from: https://doi.org/10.1186/s12916-023-02957-w\u003c/li\u003e\n\u003cli\u003eOlogunde R, Maruthappu M, Shanmugarajah K, Shalhoub J. Surgical care in low and middle-income countries: Burden and barriers. Int J Surg [Internet]. 2014;12:858\u0026ndash;63. Available from: http://dx.doi.org/10.1016/j.ijsu.2014.07.009\u003c/li\u003e\n\u003cli\u003eMeara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386:569\u0026ndash;624. \u003c/li\u003e\n\u003cli\u003eCarlos Junior T, Franca SA, Okamoto VN, Salge JM, Carvalho CRR. Infection as an independent risk factor for mortality in the surgical intensive care unit. Clinics. 2013;68:1103\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eNantulu C, Makulo J-R, Lepira FB, Shamamba R, Nlandu YM, Amisi EB, et al. 3-Survie-et-predicteurs-de-la-mortalite-des-patients-admis-au-Service-de-Reanimation-polyvalente-compresse.pdf. Ann Africaines M\u0026eacute;decine. 2021; \u003c/li\u003e\n\u003cli\u003eAbate SM, Basu B, Jemal B, Ahmed S, Mantefardo B, Taye T. Pattern of disease and determinants of mortality among ICU patients on mechanical ventilator in Sub-Saharan Africa: a multilevel analysis. Crit Care [Internet]. 2023;27:1\u0026ndash;13. Available from: https://doi.org/10.1186/s13054-023-04316-w\u003c/li\u003e\n\u003cli\u003eAlamaw AW, Abebe GK, Abate BB, Tilahun BD, Yilak G, Birara WA, et al. Mortality and associated factors among intensive care unit admitted adult patients with mechanical ventilation in ethiopia: A systematic review and meta-analysis. Shock [Internet]. 2024;61:660\u0026ndash;5. Available from: https://journals.lww.com/shockjournal/abstract/2024/05000/mortality_and_associated_factors_among_intensive.3.aspx\u003c/li\u003e\n\u003cli\u003eThe World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. 2008;1\u0026ndash;5. Available from: https://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2008.pdf\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Intensive care unit, Heal Africa Hospital, Mortality, Critical Surgical Patient","lastPublishedDoi":"10.21203/rs.3.rs-5968698/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5968698/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eProviding critical care is essential for improving health outcomes, particularly in low-resource settings such as the Democratic Republic of the Congo (DRC). However, there is a significant lack of data regarding the management and outcomes of surgical critically ill patients in this region. This study aimed to investigate the factors associated with mortality among surgical patients admitted to the intensive care unit (ICU) at HEAL Africa Hospital in eastern DRC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cross-sectional study analyzed data from surgical patients admitted to the ICU between January 2021 and June 2023. Information was extracted from the ICU registry, including demographics, reasons for admission, management details, length of stay, and mortality rates. Categorical data were presented as frequencies, and logistic regression was used, with a p-value of less than 0.05 considered significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOut of 807 patients admitted to the ICU, 368 were surgical patients (43.12%). The cohort had a male predominance (1.6:1) with a median age of 31 years. The primary reason for admission was postoperative monitoring (57.2%). The overall mortality rate was 21.3%. Univariate analysis identified statistically significant risk factors for increased mortality: male sex (p = 0.004), age (p = 0.0409), need for mechanical ventilation (p \u0026lt; 0.0001), involvement in neurosurgery (p = 0.03), and non-operative management (p \u0026lt; 0.0001). Multivariate analysis confirmed that the need for mechanical ventilation (p \u0026lt; 0.0001) and the non-operative management (p \u0026lt; 0.0001) was significantly associated with increased mortality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe burden of surgical critically ill patients in eastern DRC is substantial. Non-operative management and the requirement for mechanical ventilation were identified as factors influencing mortality among these patients. To tackle this pressing issue, it is essential to enhance critical care protocols, invest in the training of healthcare professionals, and allocate resources effectively.\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e","manuscriptTitle":"Factors Associated with Mortality in Surgical Patients Admitted to a Low-Resource Mixed Intensive Care Unit: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-18 08:54:52","doi":"10.21203/rs.3.rs-5968698/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-02T14:29:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T15:57:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-27T23:27:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154971927294158341348907984992268248623","date":"2025-05-19T21:29:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"188000542997580409907381436052762668935","date":"2025-05-19T09:52:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"249574061873601140246136166312067573689","date":"2025-05-17T07:04:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-16T12:00:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"136826211932387927780464668230211244279","date":"2025-05-16T11:50:17+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-15T19:52:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-15T19:51:20+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-27T13:59:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-03-24T16:21:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"416e8f8a-cb6d-4958-9b0d-f687926f7bb4","owner":[],"postedDate":"May 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:05:54+00:00","versionOfRecord":{"articleIdentity":"rs-5968698","link":"https://doi.org/10.1186/s12893-025-03031-3","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-07-03 15:58:06","publishedOnDateReadable":"July 3rd, 2025"},"versionCreatedAt":"2025-05-18 08:54:52","video":"","vorDoi":"10.1186/s12893-025-03031-3","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03031-3","workflowStages":[]},"version":"v1","identity":"rs-5968698","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5968698","identity":"rs-5968698","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}