Routine postoperative intensive care unit admission after colorectal cancer surgery for the elderly patient reduces postoperative morbidity and mortality

Abstract

Aim Older colorectal cancer (CRC) patients are at increased risk of postoperative morbidity and mortality. Routine postoperative overnight intensive care unit (ICU) admission might reduce this risk. This study aimed to examine the effect of routine overnight ICU admission after CRC surgery on postoperative adverse outcomes and costs in patients aged 80 years or older. Methods Patients aged 80 years or older who underwent CRC surgery in our centre were included in this observational cohort study. All patients in the period 2014–2017 with routine overnight ICU admission were assigned to the ICU cohort; all patients in the period 2009–2013 were assigned to the non‐ICU cohort. Multivariable logistic regression was performed to compare the primary composite end‐point (30‐day mortality, serious complications and readmission) between the groups. Cost data from the literature were used to perform a cost analysis. Results A total of 242 patients were included, 125 in the ICU cohort and 117 in the non‐ICU cohort. Routine overnight ICU admission was associated with a reduced risk of the composite end‐point (OR 0.44, 95% CI 0.22–0.87, P = 0.02) after adjusting for important confounders. In the ICU cohort 28% of patients experienced ICU events requiring intervention; this was not associated with postoperative morbidity or mortality. The 9% reduction in the incidence of serious complications in the ICU cohort is sufficient to offset the additional costs of routine overnight ICU admission. Conclusion Routine overnight ICU admission after CRC surgery in patients aged 80 years and older is associated with reduced risk of postoperative mortality and morbidity and seems to be cost‐effective.

Perioperative Outcomes for Centers Routinely Admitting Postoperative Endovascular Aortic Aneurysm Repair to the ICU

“…1,10,11 Others have shown routine postoperative ICU care for pancreatic, lung, and liver resections to be unnecessary, particularly as these procedures have become more minimally invasive. [12][13][14][15][16] Our goal was to assess outcomes after routine ICU admission after elective uncomplicated infrarenal EVAR. The Vascular Quality Initiative (VQI) allows for unique center-specific longitudinal data to classify an individual site as a routine ICU (rICU) and a nonroutine (nrICU) site after EVAR.…”

Surgical Apgar score is strongly associated with postoperative ICU admission

“…When the SAS was used, the rate of postoperative ICU admission was slightly, but insignificantly, increased, and the occurrences of morbidity and mortality remained unchanged 33 . The similar rates of morbidity and mortality suggest that appropriate ICU admission immediately after surgery might reduce morbidity and mortality 3,4 . Nevertheless, the study did not www.nature.com/scientificreports/ address whether the use of the SAS can decrease unplanned and delayed ICU admission, which are associated with higher mortality 3,4 .…”

“…The similar rates of morbidity and mortality suggest that appropriate ICU admission immediately after surgery might reduce morbidity and mortality 3,4 . Nevertheless, the study did not www.nature.com/scientificreports/ address whether the use of the SAS can decrease unplanned and delayed ICU admission, which are associated with higher mortality 3,4 . There were several limitations of our study.…”

Reducing morbidity and mortality in the elderly population with colorectal cancer

“…The study by Fahim et al . [8] is one of many studies that are required to provide better care for all of our patients.…”

“…The study in this issue of Colorectal Disease addresses the vulnerability of the older patient in another manner by adding postoperative interventions [8]. This is an interesting approach, that in no aspect rules out a prehabilitation and perhaps even intensified prehabilitation amongst the frail.…”