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Observational Study
. 2018 Sep 1;153(9):834-840.
doi: 10.1001/jamasurg.2018.1571.

Characteristics and Outcomes of Surgical Patients With Solid Cancers Admitted to the Intensive Care Unit

Kathryn Puxty  1 , Philip McLoone  2 , Tara Quasim  3 , Billy Sloan  2 , John Kinsella  3 , David S Morrison  4   2
Affiliations
Observational Study

Characteristics and Outcomes of Surgical Patients With Solid Cancers Admitted to the Intensive Care Unit

Kathryn Puxty et al. JAMA Surg. .

Abstract

Importance: 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.

Objective: To compare the clinical characteristics and outcomes of surgical patients with and without cancer who are admitted to ICUs.

Design, setting, and participants: 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.

Exposures: 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.

Main outcomes and measures: 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).

Results: 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.

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: Drs Quasim and Morrison and Messrs McLoone and Sloan receive salary support from Cancer Research UK. No other disclosures were reported.

Figures

Figure.
Figure.. Survival Analysis of Patients With and Without Cancer Following Surgical Intensive Care Unit Admission
There was a statistically significant difference in survival by log-rank test (P < .001).
See this image and copyright information in PMC

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