open access
Postoperative gynecologic oncology admissions to intensive care unit in the tertiary care center: an eight-year retrospective study
Affiliations- Department of Anesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Cracow, Poland
- Department of Obstetrics and Gynaecology, Jagiellonian University Medical College, Cracow, Poland, Poland
- Department of Gynecological Endocrinology and Gynecology, University Hospital, Cracow, Poland, Poland
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Cracow, Poland
- Department of Anesthesiology and Intensive Care Medicine, 5th Military Hospital with Polyclinic, Cracow, Poland
open access
Abstract
Objectives: The purpose of the study was to analyze the cohort of gynecologic oncology patients admitted to intensive care unit (ICU). Material and methods: We conducted a retrospective study including all ICU postoperative admissions related to adult female patients with gynecological malignancies diagnosis treated in the tertiary care center between Jan 1, 2007, and Dec 31, 2014. Results: A total of 666 women were admitted to ICU. It accounted for 2 % of all tertiary care center gynecology admissions. The mean age was 62.4 ± 12.7 years, and the mean length of stay was 8.9 ± 9.6 days. One hundred seventeen women (17.5%) required mechanical ventilation, and 220 women (33%) vasoactive drug infusion. The most common malignancy in the observed cohort of patients was ovarian cancer 326 (48.9%), followed by endometrial cancer 206 (30.9%). The patients with respiratory or circulatory insufficiency were older (mean age 64.9 ± 11.8 vs 60.8 ± 13; p < 0.001) and had longer mean ICU stay (13.1 ± 13.9 vs 6.3 ± 3.5 days; p < 0.001). We found a decrease in ICU admissions of patients without respiratory and circulatory failure after elective major surgery (Spearman: r = –1, p = 0.017). We report 21 patients’ deaths (3.1% in the cohort; 0.06% of all admissions). Conclusions: Ovarian cancer patients were the largest group in the study, representing almost half of ICU admissions in the gynecology oncologic population. Older age was the risk factor of respiratory and circulatory insufficiency. Availability of intermediate care facilities could reduce ICU admissions after major surgery.
Abstract
Objectives: The purpose of the study was to analyze the cohort of gynecologic oncology patients admitted to intensive care unit (ICU). Material and methods: We conducted a retrospective study including all ICU postoperative admissions related to adult female patients with gynecological malignancies diagnosis treated in the tertiary care center between Jan 1, 2007, and Dec 31, 2014. Results: A total of 666 women were admitted to ICU. It accounted for 2 % of all tertiary care center gynecology admissions. The mean age was 62.4 ± 12.7 years, and the mean length of stay was 8.9 ± 9.6 days. One hundred seventeen women (17.5%) required mechanical ventilation, and 220 women (33%) vasoactive drug infusion. The most common malignancy in the observed cohort of patients was ovarian cancer 326 (48.9%), followed by endometrial cancer 206 (30.9%). The patients with respiratory or circulatory insufficiency were older (mean age 64.9 ± 11.8 vs 60.8 ± 13; p < 0.001) and had longer mean ICU stay (13.1 ± 13.9 vs 6.3 ± 3.5 days; p < 0.001). We found a decrease in ICU admissions of patients without respiratory and circulatory failure after elective major surgery (Spearman: r = –1, p = 0.017). We report 21 patients’ deaths (3.1% in the cohort; 0.06% of all admissions). Conclusions: Ovarian cancer patients were the largest group in the study, representing almost half of ICU admissions in the gynecology oncologic population. Older age was the risk factor of respiratory and circulatory insufficiency. Availability of intermediate care facilities could reduce ICU admissions after major surgery.
Keywords
intensive care; gynecologic oncology; critical care; admission; risk factor
About this articleTitle
Postoperative gynecologic oncology admissions to intensive care unit in the tertiary care center: an eight-year retrospective study
Journal
Issue
Article type
Research paper
Published online
2022-11-22
Page views
165
Article views/downloads
100
DOI
10.5603/GP.a2022.0133
Pubmed
Keywords
intensive care
gynecologic oncology
critical care
admission
risk factor
Authors
Pawel Krawczyk
Dominika Trojnarska
Rafal Baran
Tomasz Lonc
Rafal Swistek
Pawel Tyszecki
Robert Jach
References (32)- Pearse R, Moreno R, Bauer P, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380(9847): 1059–1065.
- Ludność w województwie Małopolskim. Urodzenia w województwie Małopolskim. https://krakow.stat.gov.pl/dane-o-wojewodztwie/wojewodztwo-918/ludnosc/ (10.02.2022).
- R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.r-project.org/ (10.02.2022).
- American Cancer Society. Cancer facts & figures 2021. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2021/cancer-facts-and-figures-2021.pdf (10.02.2022).
- Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71(3): 209–249.
- Ross MS, Burriss ME, Winger DG, et al. Unplanned postoperative intensive care unit admission for ovarian cancer cytoreduction is associated with significant decrease in overall survival. Gynecol Oncol. 2018; 150(2): 306–310.
- Epidemiology of Endometrial Cancer Consortium (E2C2). https://epi.grants.cancer.gov/eecc/ (10.02.2022).
- Fronczek J, Polok KJ, Nowak-Kózka I, et al. Frailty is associated with an increased mortality among patients ≥ 80 years old treated in Polish ICUs. Anaesthesiol Intensive Ther. 2018; 50(4): 245–251.
- Raspé C, Flöther L, Schneider R, et al. Best practice for perioperative management of patients with cytoreductive surgery and HIPEC. Eur J Surg Oncol. 2017; 43(6): 1013–1027.
- Michard F, Lopes MR, Auler JOC. Pulse pressure variation: beyond the fluid management of patients with shock. Crit Care. 2007; 11(3): 131.
- Marik PE, Cavallazzi R, Vasu T, et al. Dynamic changes in arterial waveform derived variables and fluid responsiveness in mechanically ventilated patients: a systematic review of the literature. Crit Care Med. 2009; 37(9): 2642–2647.
- Díaz-Montes TP, Zahurak ML, Bristow RE. Predictors of extended intensive care unit resource utilization following surgery for ovarian cancer. Gynecol Oncol. 2007; 107(3): 464–468.
- Pepin K, Bregar A, Davis M, et al. Intensive care admissions among ovarian cancer patients treated with primary debulking surgery and neoadjuvant chemotherapy-interval debulking surgery. Gynecol Oncol. 2017; 147(3): 612–616.
- Ruskin R, Urban RR, Sherman AE, et al. Predictors of intensive care unit utilization in gynecologic oncology surgery. Int J Gynecol Cancer. 2011; 21(8): 1336–1342.
- Thomakos N, Zacharakis D, Rodolakis A, et al. Gynecologic oncology patients in the surgical high dependency unit: an analysis of indications. Arch Gynecol Obstet. 2014; 290(2): 335–339.
- Hallqvist L, Granath F, Fored M, et al. Intraoperative hypotension and myocardial infarction development among high-risk patients undergoing noncardiac surgery: a nested case-control study. Anesth Analg. 2021; 133(1): 6–15.
- Gregory A, Stapelfeldt W, Khanna A, et al. Intraoperative hypotension is associated with adverse clinical outcomes after noncardiac surgery. Anesth Analg. 2021; 132(6): 1654–1665.
- Pearse RM, Harrison DA, James P, et al. Identification and characterisation of the high-risk surgical population in the United Kingdom. Crit Care. 2006; 10(3): R81.
- Jhanji S, Thomas B, Ely A, et al. Mortality and utilisation of critical care resources amongst high-risk surgical patients in a large NHS trust. Anaesthesia. 2008; 63(7): 695–700.
- Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011; 112(6): 1392–1402.
- Sobol J, Wunsch H. Triage of high-risk surgical patients for intensive care. Crit Care. 2011; 15(2): 217.
- Onwochei DN, Fabes J, Walker D, et al. Critical care after major surgery: a systematic review of risk factors for unplanned admission. Anaesthesia. 2020; 75 Suppl 1: e62–e74.
- Smeenk RM, Verwaal VJ, Zoetmulder FAN. Learning curve of combined modality treatment in peritoneal surface disease. Br J Surg. 2007; 94(11): 1408–1414.
- Yan TD, Links M, Fransi S, et al. Learning curve for cytoreductive surgery and perioperative intraperitoneal chemotherapy for peritoneal surface malignancy - a journey to becoming a Nationally Funded Peritonectomy Center. Ann Surg Oncol. 2007; 14(8): 2270–2280.
- Mohamed F, Moran BJ. Morbidity and mortality with cytoreductive surgery and intraperitoneal chemotherapy: the importance of a learning curve. Cancer J. 2009; 15(3): 196–199.
- Gustafsson UO, Scott MJ, Schwenk W, et al. Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care, European Society for Clinical Nutrition and Metabolism (ESPEN), International Association for Surgical Metabolism and Nutrition (IASMEN). Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS(®)) Society recommendations. World J Surg. 2013; 37(2): 259–284.
- Nelson G, Altman AD, Nick A, et al. Guidelines for pre- and intra-operative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations - Part I. Gynecol Oncol. 2016; 140(2): 313–322.
- Nelson G, Altman AD, Nick A, et al. Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations--Part II. Gynecol Oncol. 2016; 140(2): 323–332.
- Aygencel G, Turkoglu M, Turkoz Sucak G, et al. Prognostic factors in critically ill cancer patients admitted to the intensive care unit. J Crit Care. 2014; 29(4): 618–626.
- Staudinger T, Stoiser B, Müllner M, et al. Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit. Crit Care Med. 2000; 28(5): 1322–1328.
- Taccone FS, Artigas AA, Sprung CL, et al. Characteristics and outcomes of cancer patients in European ICUs. Crit Care. 2009; 13(1): R15.
- Nates JL, Nunnally M, Kleinpell R, et al. ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. Crit Care Med. 2016; 44(8): 1553–1602.
