Outcomes of early versus delayed surgical intervention for critically ill patients in the intensive care unit: A systematic review

Abstract

The timing of surgical intervention in critically ill ICU patients remains a pivotal yet complex decision, balancing the urgency of source control against the risks of operative stress. This systematic review synthesizes evidence from 20 studies to compare outcomes of early versus delayed surgical intervention across various conditions, including abdominal emergencies, trauma, and neurological cases.

Findings reveal that optimal timing is highly condition-specific. Time-critical conditions such as acute intestinal ischemia, necrotizing soft tissue infections, and free intestinal perforation demonstrate significantly reduced mortality with early intervention (within 4–12 hours), while delays beyond these thresholds are associated with poorer outcomes. On the other hand, conditions like necrotizing pancreatitis with persistent organ failure and blunt carotid injury show increased mortality with early surgery, emphasizing the need for initial physiological stabilization.

Early intervention consistently reduced ICU and hospital length of stay (LOS) and complications such as ventilator-associated pneumonia (e.g., tracheostomy ≤10 days) and pressure ulcers (e.g., hip fractures <48 hours). However, premature surgery in high-risk scenarios, such as necrotizing enterocolitis or pancreatitis with organ failure, paradoxically worsens outcomes. Resource utilization improved with early laparoscopic cholecystectomy (reduced costs and LOS) and decompressive craniotomy for malignant MCA infarction (better functional recovery).

The review underscores that the therapeutic window for surgery depends on disease pathophysiology, patient stability, and procedural risks. While early intervention benefits time-sensitive conditions, delayed surgery after optimization is preferable for systemic inflammatory or organ failure-dominated cases. Future research should refine condition-specific timing thresholds and integrate dynamic physiological markers to guide decision-making. Clinicians must tailor surgical timing to individual patient and disease profiles to optimize outcomes and resource use