Elective intensive care after lung resection: a multicentric propensity-matched comparison of outcome

Abstract

The study was aimed at assessing the influence of the elective ICU admission on the early outcome after major lung resection by analyzing the different postoperative management policies of two centers. Center A managed all patients in a dedicated ward, resorting to ICU for complications requiring invasive assisted ventilation. In center B, high-risk patients were electively transferred to ICU immediately after operation. Propensity score was used to match those patients of center B electively admitted to ICU (96 of 157), with counterparts from center A (96 of 205). The outcome of these matched pairs were then compared. There was a trend of reduced total morbidity (23% vs. 35%, respectively; P=0.06), cardiovascular (13.5% vs. 23%, respectively; P=0.09) and pulmonary complication rates (9.3% vs. 18%, respectively; P=0.09), but a longer postoperative hospital stay (11.5 vs. 9.7, respectively; P=0.015) in the patients electively admitted to ICU, compared to matched center A patients. Mortality rates were not different (7.3% vs. 7.3%; P=1). Since the elective postoperative ICU admission did not show a clear-cut outcome benefit over the management in a dedicated ward, this practice should be limited to highly selected patients in order to efficiently utilize the available resources.

Patients after lung resection heading to the high-dependency unit: a cost-effectiveness study for managing lung cancer patients

“…Our financial saving from investing in HDU has proven to save us nearly half of the cost of admission to the ITU (850 pounds/day/patient vs 430 pounds/day/patient). This is similar to a cost estimated in a similar study which has estimated that the cost of treatment in ITU is 800 pounds a day, while that would be 440 pounds a day for an HDU bed [20]. This significant difference in cost is primarily due to the nursing costs/salaries in the ITU compared to HDU due to the differences in patient-to-nurse ratio in addition to different equipment costs.…”

Failure to rescue trends in elective abdominal aortic aneurysm repair between 1995 and 2011

“…FTR has emerged as a tool for assessing surgical quality since its original definition by Silber et al 1 in 1992. FTR has been used to assess surgical quality for a variety of procedures, including thoracic, [2][3][4] aortic abdominal, [5][6][7] and general surgical procedures. [8][9][10][11] It is currently one of the Agency for Healthcare Research and Quality Patient Safety Indicators (PSI 4).…”

Immediate Postoperative Care in the General Thoracic Ward Is Safe for Low-risk Patients after Lobectomy for Lung Cancer

“…Although these two studies were not intended to analyze efficacy of GTW care, their results reflect that GTW care is not an option that compromises the health of the patient. Brunelli and colleagues conducted an important study that revealed that ICU care has no advantage over GTW care according to a multi-center propensity score matched analysis [5]. However, a limitation of that study was that although the authors performed propensity score matching to decrease heterogeneity, preoperative, operative and postoperative management of the two groups were wholly different.…”

“…Due to early diagnosis and extension of surgical indications, cases of major lung resection due to lung cancer have been increasing; therefore, the demand for ICU care has also been expected to increase. High-dependency unit (HDU) care is recommended as an alternative to ICU stays for postoperative lung resection patients [5]. However, many institutions do not include an HDU because it requires specialized medical personnel and resources [6].…”