Perioperative predictors of critical care admission following emergency surgical procedures: a comprehensive evaluation of anesthesia management

Emergency surgical procedures carry substantial risk, with increased morbidity, mortality, and unplanned intensive care unit (ICU) admissions. Identifying perioperative factors associated with postoperative ICU requirement is essential for improving outcomes and optimizing resource allocation. This study evaluated anesthesia management practices in a large emergency surgery cohort and investigated independent predictors of postoperative ICU admission. This retrospective cohort study included 1,984 patients who underwent emergency surgical procedures at a tertiary center between 2022 and 2023. Demographics, trauma status, ASA classification, airway management, anesthetic technique, hemodynamic support, transfusion, and postoperative analgesia were recorded. The primary endpoint was postoperative ICU admission. The ICU admission rate was 12.1%. ICU-admitted patients were older (57.5 ± 19.1 vs. 36.9 ± 15.2 years, p < 0.001) and more frequently presented with trauma (30.8% vs. 16.0%, p < 0.001). Higher ASA scores, vasopressor or inotrope use (19.9% vs. 0.3%, p < 0.001), and transfusion (32.1% vs. 3.6%, p < 0.001) were strongly associated with ICU need. Multivariate analysis identified age (OR:1.027), trauma (OR:1.606), ASA score (OR:4.376), vasopressor or inotrope use (OR:24.408), and transfusion (OR:4.952) as independently associated factors (all p < 0.05). Specialties showed notable variation in anesthetic technique and postoperative practices. Postoperative ICU requirement in emergency surgery is associated with advanced age, trauma, elevated ASA status, hemodynamic instability, and transfusion. Recognizing these predictors may help inform risk stratification, perioperative planning, and ICU resource utilization. Standardizing anesthesia protocols and strengthening hemodynamic optimization strategies may help inform perioperative risk stratification and ICU resource allocation.