Postoperative complications: does intensive care unit staff nursing make a difference?

OBJECTIVE The purpose of this study was to examine the association between intensive care unit nurse (ICU) staffing and the likelihood of complications for patients undergoing abdominal aortic surgery. DESIGN The study is a retrospective review of hospital discharge data linked to data on ICU organizational characteristics. SETTING Research took place in ICUs in non-federal, short-stay hospitals in Maryland. PATIENTS Study included 2606 patients undergoing abdominal aortic surgery in Maryland between January 1994 and December 1996. OUTCOME MEASURES Outcome measures included cardiac, respiratory, and other complications. RESULTS Cardiac complications occurred in 13% of patients, respiratory complications occurred in 30%, and other complications occurred in 8% of patients. Multiple logistic regression revealed a statistically significant increased likelihood of respiratory complications (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.50-3.60) in abdominal aortic surgery patients cared for in ICUs with low- versus high-intensity nurse staffing, an increased likelihood of cardiac complications (OR, 1.78; CI, 1.16-2.72) and other complications (OR, 1.74; CI, 1.15-2.63) in ICUs with medium- versus high-intensity nurse staffing, after controlling for patient and organizational characteristics. CONCLUSIONS Within the range of ICU nurse staffing levels present in Maryland hospitals, decreased nurse staffing was significantly associated with an increased risk of complications in patients undergoing abdominal aortic surgery.

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