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Intensive care unit utilization after esophagectomy
Critical Care volume 11, Article number: P496 (2007)
At our institution, postesophagectomy patients are usually managed in a progressive care unit with ICU admission reserved for those of high acuity. We hypothesized that ICU admission after esophagectomy is predictable and associated with high mortality.
A retrospective analysis of all patients after esophagectomy between January 2000 and June 2004 at a tertiary referral center. Data regarding demographics, preoperative morbidities, perioperative complications, APACHE III predictions, mortality, and lengths of stay were collected.
Four hundred and thirty-two patients underwent esophagectomy during the study period: 123 (28.5%) were admitted to the ICU (ICUGP) and 309 (71.5%) were not (NICUGP). Overall mortality was 3.7% (16 of 432 patients). Fifteen of 123 in ICUGP died in hospital (12.2%) compared with one of 309 in NICUGP. For ICUGP, mean (± standard deviation) acute physiology and APACHE III scores were 41.8 (± 16.6) and 54.5 (± 18.1), respectively. Forty-seven percent of ICUGP had a new (versus pre-existing postoperative) infiltrate on chest Xray, 21.8% had positive sputum/bronchial culture and 5% positive blood culture within 48 hours of ICU admission. A total 13.8% of ICUGP had 'aspiration' documented in physician notes. The median (IQR) ICU and hospital lengths of stay were 3.6 (1.7–9.9) and 17.0 (11.3–33.9) days, respectively. Compared with NICUGP, patients in ICUGP were more likely to have developed postoperative arrhythmia (57.9% vs 12.9%, P < 0.001), were older, of higher ASA status, and more likely to have diabetes, coronary artery disease, hypertension, a higher cancer stage, and to have received more intraoperative blood products. Of 352 patients originally not sent to the ICU, 43 (12.2%) were subsequently admitted to the ICU. These patients had higher APACHE III scores and were more likely to have 'aspiration' documented, although their mortality was not higher than direct ICU admissions.
After esophagectomy, overall mortality is low, but many patients require ICU admission. Postoperative arrhythmias and aspiration pneumonitis are especially problematic.
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Iscimen, R., Brown, D., Whalen, F. et al. Intensive care unit utilization after esophagectomy. Crit Care 11, P496 (2007). https://0-doi-org.brum.beds.ac.uk/10.1186/cc5656
- Positive Blood Culture
- High Apache
- Aspiration Pneumonitis
- Physician Note
- Postoperative Arrhythmia