Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality

Abstract

BackgroundThe aim of this study was to identify risk factors associated with mortality in patients re‐admitted to an intensive care unit (ICU) after initial recovery from major lung resection.MethodsWe retrospectively reviewed the case records of all patients who underwent major lung resection between February 2011 and May 2013. A total of 1916 patients underwent major resection surgery for various lung diseases, 63 (3.3%) of which required ICU admission after initial recovery. We analyzed preoperative and perioperative data, including ICU factors and outcomes.ResultsThe patient group included 57 men (90.5%) with a mean age of 65.3 years. Pathologic diagnosis was malignancy in 92.1% of patients, while 7.9% had benign disease. Open thoracotomy was performed in 84.1%, whereas minimally invasive approaches were performed in 15.9%. In‐hospital mortality occurred in 16 (25.4%) patients. Patients were classified as either survivors (n = 47, 74.6%) or non‐survivors (n = 16, 25.4%). The most common reason for ICU readmission was pulmonary complication (n = 50, 79.4%). Thirty‐one patients (49.2%) required mechanical ventilation, seven (11.1%) required extracorporeal membrane oxygenation, and three (4.8%) required renal support. Multivariate analysis showed that acute respiratory distress syndrome (ARDS) and delirium were independent risk factors for in‐hospital mortality. In addition, delirium frequently occurred in patients with ARDS.Conclusion ARDS and delirium were independent risk factors for in‐hospital mortality in patients who were readmitted to the ICU after major lung resection. Future studies are needed to determine if the prevention of delirium and ARDS can improve postoperative outcomes for patients with lung cancer.

Risk factors for intensive care unit readmission after lung transplantation: a retrospective cohort study

“…In this study, 32 patients (24.6%) were readmitted to the ICU before hospital discharge after LT, which was lower than reported in an earlier study that showed an ICU readmission rate of 44% during the first 90 days after LT [8]. However, the readmission rate is higher than that observed in other studies [4,9]. Thirteen (10%) patients died during hospitalization, and the number of ICU readmissions was significantly associated with in-hospital mortality (HR, 21.34 for ICU readmission once; HR, 34.12 for ICU readmission twice or thrice) at a much stronger level than in previous reports [3,4].…”

“…There have been steady efforts to develop prediction models for early unpredicted ICU readmission after initial ICU discharge in various patient groups [9,[18][19][20][21]. However, no consensus model is commonly used.…”

Risk Factors for Intensive Care Unit Readmission After Liver Transplantation: A Retrospective Cohort Study

“…The ICU readmission rate of our study is similar to that of a previous study of medical and surgical ICU patients, which showed ICU readmission rates between 4% and 10% [ 5 ]. In other high-risk surgical populations, ICU readmission rates were 3.3% after lung resection [ 10 ] and 3.6% after cardiac surgery [ 11 ].…”

Outcome following unplanned critical care admission after lung resection

“…A large retrospective American database study was recently published that reported broadly similar reintubation rates (3.5% reintubation rate vs 2.1% need for unplanned mechanical ventilation in the current cohort) and survival (28.7% 30-day mortality vs 35.3% hospital mortality in current cohort); it did not, however, address critical care resource use nor outcome. 5 The critical care survival in the current cohort compares favorably with historical datasets in which critical care mortality was reported at 25% to 46% [6][7][8][9][10] (summarized in Table E1). This comparison is made more encouraging by the observation that in many cases the inclusion criteria to qualify as an "critical care admission" in the previous studies is less stringent than that used in the current study and would be likely to reflect a less-sick group of patients (definitions are summarized in Table E1).…”