A population-based analysis of long-term outcomes among older adults requiring unexpected intensive care unit admission after cancer surgery
Tillmann BW, Hallet J, Guttman MP, Coburn N, Chesney T, Zuckerman J, Mahar A, Zuk V, Chanv WC, Haas B; REcovery after Surgical Therapy for Older adults Research—Cancer (RESTORE-C) group. Ann Surg Oncol. 2021; 28(12):7014-24. Epub 2021 Aug 24. DOI: https://doi.org/10.1245/s10434-021-10705-8
Background — High-intensity cancer surgery is increasingly common among older adults. However, these patients are at high-risk for unexpected intensive care unit (ICU) admissions after surgery. How these admissions impact older adults’ long-term outcomes is unknown.
Methods — We performed a population-based, cohort study of older adults (age ≥ 70 years) who underwent high-intensity cancer surgery from 2007 to 2017. Analyses were performed to examine time alive and at home following surgery, defined as time from surgery to nursing home admission or death. Patients were followed for up to 5 years. Extended Cox proportional hazards models examined the independent association between unexpected ICU admission (ICU admissions excluding routine postoperative monitoring) and remaining alive and at home. Subgroup analysis stratified patients by duration of mechanical ventilation (MV).
Results — Of 47,367 identified older adults, 7372 (15.6%) had an unexpected ICU admission. Patients with an unexpected ICU admission had a significantly lower probability of being alive and at home at 5 years (26.2%; 95% confidence interval [CI] 25.1–27.2%) compared with those without an unexpected admission (56.8%; 95% CI 56.3–57.4%). After adjusting for baseline characteristics, unexpected ICU admission remained associated with less time alive and at home. The elevated risk of death or nursing home admission persisted for 5 years after surgery (years 2–5: hazard ratio [HR] 1.58, 95% CI 1.50–1.66). Duration of MV was inversely associated with time alive and at home.
Conclusions — Older adults with an unexpected ICU admission after high-intensity cancer surgery are at increased risk for death or admission to a nursing home for at least 5 years.