Post-intensive care unit syndrome in gynecologic oncology patients

Abstract

Purpose: The purposes of the present study are to describe the demographic and treatment characteristics of women on the gynecologic oncology service who required intensive care and assess prevalence of risk factors for post-intensive care syndrome (PICS).

Methods: A retrospective chart review was performed encompassing patients requiring admission to the intensive care unit (ICU) on the gynecology oncology service between 1/2008 and 12/2012. Descriptive statistics were computed using SAS version 9.3.

Results: One hundred eleven patients met study criteria. Most were Caucasian (85 %), were married (50 %), and had stage III/IV disease (82 %). Risk factors for PICS were as follows: 9 % had baseline anxiety, 20 % had baseline depression, 21 % were taking an SSRI prior to admission, and 18 % took other psychiatric medications. Most ICU admissions (47 %) were for planned post-operative management. Thirty-seven percent required mechanical ventilation for a median of 1 day (range, 1-24). Twenty percent required new scheduled psychiatric medications while in the ICU, and 8.1 % of patients were discharged with a newly prescribed antidepressant. Of patients, 15.3 % had consultations with psychiatry or social work. Six percent of patients expired, and 18 % had a nontraditional discharge disposition. Overall, 60 % of the patients had at least one recognized risk factor for PICS.

Conclusions: Given the preponderance of psychiatric disorders and mechanical ventilation during post-operative ICU care in patients with gynecologic cancer, prospective evaluation of risk factors and utility of risk-reducing interventions for PICS is warranted. Long-term cognitive or physical disability is known to hasten mortality; thus, preventative strategies may increase the survival and quality of life for this patient population.

Keywords: Gynecologic oncology; Intensive care unit; PICS; Post-intensive care syndrome; Psychiatric.