Characteristics and outcomes of surgical patients with solid cancers admitted to the intensive care unit

Puxty, K. , McLoone, P., Quasim, T. , Sloan, B., Kinsella, J. and Morrison, D. S. (2018) Characteristics and outcomes of surgical patients with solid cancers admitted to the intensive care unit. JAMA Surgery, 153(9), pp. 834-840. (doi:10.1001/jamasurg.2018.1571) (PMID:29955801) (PMCID:PMC6233642)

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Abstract

Within the surgical population admitted to intensive care units (ICUs), cancer is a common condition. However, clinicians can be reluctant to admit patients with cancer to ICUs owing to concerns about survival. To compare the clinical characteristics and outcomes of surgical patients with and without cancer who are admitted to ICUs. An observational retrospective cohort study using ICU audit records linked to hospitalization discharge summaries, cancer registrations, and death records of all 16 general adult ICUs in the West of Scotland was conducted. All 25 017 surgical ICU admissions between January 1, 2000, and December 31, 2011, were included, and data analysis was conducted during that time. Patients were dichotomized based on a diagnosis of a solid malignant tumor as determined by its documentation in the Scottish Cancer Registry within the 2 years prior to ICU admission. Intensive care unit patients with cancer were compared with ICU patients without cancer in terms of patient characteristics (age, sex, severity of illness, reason for admission, and organ support) and survival (ICU, hospital, 6 months, and 4 years). Within the 25 017 surgical ICU patients, 13 684 (54.7%) were male, the median (interquartile range [IQR]) age was 64 (50-74), and 5462 (21.8%) had an underlying solid tumor diagnosis. Patients with cancer were older (median [IQR] age, 68 [60-76] vs 62 [45-74] years; P < .001) with a higher proportion of elective hospitalizations (60.5% vs 19.8%; P < .001), similar Acute Physiology and Chronic Health Evaluation II scores (median for both, 17), but lower use of multiorgan support (57.9% vs 66.7%; P < .001). Intensive care unit and hospital mortality were lower for the cancer group, at 12.2% (95% CI, 11.3%-13.1%) vs 16.8% (95% CI, 16.3%-17.4%) (P < .001) and 22.9% (95% CI, 21.8%-24.1%) vs 28.1% (27.4%-28.7%) (P < .001). Patients with cancer had an adjusted odds ratio for hospital mortality of 1.09 (95% CI, 1.00-1.19). By 6 months, mortality in the cancer group was higher than that in the noncancer group at 31.3% compared with 28.2% (P < .001). Four years after ICU admission, mortality for those with and without cancer was 60.9% vs 39.7% (P < .001) respectively. Cancer is a common diagnosis among surgical ICU patients and this study suggests that initial outcomes compare favorably with those of ICU patients with other conditions. Consideration that a diagnosis of cancer should not preclude admission to the ICU in patients with surgical disease is suggested.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Quasim, Dr Tara and McLoone, Mr Philip and Kinsella, Professor John and Puxty, Dr Kathryn and Morrison, Dr David and Sloan, Mr William
Authors: Puxty, K., McLoone, P., Quasim, T., Sloan, B., Kinsella, J., and Morrison, D. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > General Practice and Primary Care
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Public Health
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:JAMA Surgery
Publisher:American Medical Association
ISSN:2168-6254
ISSN (Online):2168-6262
Published Online:27 June 2018
Copyright Holders:Copyright © 2018 Puxty K et al.
First Published:First published in JAMA Surgery 153(9): 834-840
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
604522Outcome of cancer patients with critical illness requiring intensive care admissionDavid MorrisonCancer Research UK (CRUK)16662IHW - PUBLIC HEALTH