Harveshp D Mogal1, Edward A Levine1, Nora F Fino2, Chukwuemeka Obiora1, Perry Shen1, John H Stewart1, Konstantinos I Votanopoulos3. 1. Surgical Oncology Service, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA. 2. Department of Biostatistical Sciences, Wake Forest Baptist Health, Winston-Salem, NC, USA. 3. Surgical Oncology Service, Department of General Surgery, Wake Forest Baptist Health, Winston-Salem, NC, USA. kvotanop@wakehealth.edu.
Abstract
BACKGROUND: Routine postoperative intensive care unit (ICU) observation of patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is driven by historically reported morbidity and mortality data. The validity of this practice and the criteria for ICU admission have not been elucidated. METHODS: A prospectively maintained database of 1146 CRS/HIPEC procedures performed from December 1991 to 2014 was retrospectively analyzed. Patients with routine postoperative ICU admission were compared with patients sent directly to the surgical floor. To test the safety of non-ICU care practice, patients with less than 48 h ICU admission were compared with patients directly admitted to the floor. Demographics, primary tumor site, comorbidities, estimated blood loss (EBL), extent of CRS, Eastern Cooperative Oncology Group (ECOG) status, and overall survival were analyzed. RESULTS: Complete data were available for 1064 CRS/HIPEC procedures, of which 244 cases (22.93 %) did not require ICU admission. Multivariate logistic regression identified age [odds ratio (OR) 1.024; p = 0.02], EBL (OR 1.002; p < 0.0001), number of resected organs (OR 1.308; p = 0.01) and ECOG > 2 (OR 6.387; p = 0.003) as predictive variables of postoperative ICU admission. The cohort directly admitted to the floor demonstrated less minor grade I/II morbidity (29 vs. 47 %; p < 0.0001) and similar grade III/IV major morbidity (16.5 vs. 13.4 %; p = 0.3) than the patients admitted to the ICU for less than 48 h. CONCLUSIONS: ICU observation is not routinely required for all patients treated with CRS/HIPEC. Selective ICU admission based on ECOG status, nutritional status, age, EBL, and CRS extent is safe, with potential implications for hospitalization cost for these complex cases.
BACKGROUND: Routine postoperative intensive care unit (ICU) observation of patients undergoing cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is driven by historically reported morbidity and mortality data. The validity of this practice and the criteria for ICU admission have not been elucidated. METHODS: A prospectively maintained database of 1146 CRS/HIPEC procedures performed from December 1991 to 2014 was retrospectively analyzed. Patients with routine postoperative ICU admission were compared with patients sent directly to the surgical floor. To test the safety of non-ICU care practice, patients with less than 48 h ICU admission were compared with patients directly admitted to the floor. Demographics, primary tumor site, comorbidities, estimated blood loss (EBL), extent of CRS, Eastern Cooperative Oncology Group (ECOG) status, and overall survival were analyzed. RESULTS: Complete data were available for 1064 CRS/HIPEC procedures, of which 244 cases (22.93 %) did not require ICU admission. Multivariate logistic regression identified age [odds ratio (OR) 1.024; p = 0.02], EBL (OR 1.002; p < 0.0001), number of resected organs (OR 1.308; p = 0.01) and ECOG > 2 (OR 6.387; p = 0.003) as predictive variables of postoperative ICU admission. The cohort directly admitted to the floor demonstrated less minor grade I/II morbidity (29 vs. 47 %; p < 0.0001) and similar grade III/IV major morbidity (16.5 vs. 13.4 %; p = 0.3) than the patients admitted to the ICU for less than 48 h. CONCLUSIONS: ICU observation is not routinely required for all patients treated with CRS/HIPEC. Selective ICU admission based on ECOG status, nutritional status, age, EBL, and CRS extent is safe, with potential implications for hospitalization cost for these complex cases.
Authors: N Bakrin; J M Bereder; E Decullier; J M Classe; S Msika; G Lorimier; K Abboud; P Meeus; G Ferron; F Quenet; F Marchal; S Gouy; P Morice; C Pomel; M Pocard; F Guyon; J Porcheron; O Glehen Journal: Eur J Surg Oncol Date: 2013-10-17 Impact factor: 4.424
Authors: John C Bell; Barnaby G Rylah; Robert W Chambers; Helen Peet; Faheez Mohamed; Brendan J Moran Journal: Ann Surg Oncol Date: 2012-07-18 Impact factor: 5.344
Authors: Vic J Verwaal; Serge van Ruth; Eeclo de Bree; Gooike W van Sloothen; Harm van Tinteren; Henk Boot; Frans A N Zoetmulder Journal: J Clin Oncol Date: 2003-10-15 Impact factor: 44.544
Authors: Edward A Levine; John H Stewart; Perry Shen; Gregory B Russell; Brian L Loggie; Konstantinos I Votanopoulos Journal: J Am Coll Surg Date: 2013-12-21 Impact factor: 6.113
Authors: Patrick B Schwartz; Christopher C Stahl; Roberto J Vidri; Glen E Leverson; Yana Puckett; Syed N Zafar; Patrick Varley; Sean M Ronnekleiv-Kelly; Ahmed Al-Niaimi; Sharon M Weber; Daniel E Abbott Journal: Ann Surg Oncol Date: 2022-06-07 Impact factor: 4.339
Authors: Patrick B Schwartz; Christopher C Stahl; Kara A Vande Walle; Courtney J Pokrzywa; Linda M Cherney Stafford; Taylor Aiken; James Barrett; Alexandra W Acher; Glen Leverson; Sean Ronnekleiv-Kelly; Sharon M Weber; Daniel E Abbott Journal: Ann Surg Oncol Date: 2020-05-15 Impact factor: 5.344
Authors: Sumit Kapoor; Adel Bassily-Marcus; Rafael Alba Yunen; Parissa Tabrizian; Sabrine Semoin; Joseph Blankush; Daniel Labow; John Oropello; Anthony Manasia; Roopa Kohli-Seth Journal: World J Crit Care Med Date: 2017-05-04
Authors: Ruby M van Stein; Christianne A R Lok; Arend G J Aalbers; Ignace H J T de Hingh; Aletta P I Houwink; Herman J Stoevelaar; Gabe S Sonke; Willemien J van Driel Journal: Gynecol Oncol Rep Date: 2022-02-26