Use of the APACHE II Scoring System to Determine Mortality of Gynecologic Oncology Patients in the Intensive Care Unit

Le, Linda Van; Fakhry, Samir M.; Walton, Leslie A.; Moore, Danier; Fowler, Wesley C.; Rutledge, Robert

doi:10.1016/0029-7844(94)00308-z

Cited by 29 publications

(19 citation statements)

References 7 publications

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“…Their experience appears to represent the extreme of their patient population; therefore, it is difficult to apply their conclusions to the average gynecological oncology patient population. Overall, our findings were more similar to the work of Van Le et al, (5) with a mean APACHE II score of 21.2 for patients who died in the postoperative period. However, 11 of 22 patients (50%) with APACHE II scores of greater than 20 survived their ICU admission.…”

Section: Discussionsupporting

confidence: 92%

“…Previous experience in a combination of critically ill surgical and medical gynecological oncology patients noted a 78% mortality rate when the APACHE II score was greater than 20, as compared to 3% when the score was less than 20 (5) . However, in this series, one third of their patients were admitted for presumed medical indications as their admissions were not postoperative.…”

Section: Discussionmentioning

confidence: 95%

“…While there is extensive literature concerning critical care implementation and management of the critically ill postsurgical patients, there is surprisingly limited published data describing critically ill gynecological or gynecological oncology patients requiring postoperative ICU management (4)(5)(6)(7) . Thus, the objective of our study was to determine the outcomes of gynecological oncology patients that required postoperative observation and/or management in an ICU following surgery.…”

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confidence: 99%

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Outcomes of gynecologic oncology patients admitted to the intensive care unit following surgery: a university teaching hospital experience

Leath¹,

Kendrick²,

Numnum³

et al. 2006

International Journal of Gynecological Cancer

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The objective of this study was to determine the outcomes of gynecological oncology patients requiring intensive care unit (ICU) admission following surgery. A computerized database identified postsurgical ICU admissions from January 1, 1999 to December 31, 2004 at a university hospital. Abstracted data included: demographics, preoperative diagnosis, reason(s) for ICU admission, consultations, interventions, length of stay (LOS), Acute Physiology and Chronic Health Evaluation (APACHE) II score, and 30-day mortality. Statistical analysis was performed with the Student's t-test. A total of 185 surgical gynecological oncology ICU patients was identified. Median age was 60 years (range, 21-92 years), and 63% of patients were white. Only 72% of patients had ovarian, endometrial, or cervical cancer. The most common indications for ICU admission were volume resuscitation (108 patients) and respiratory insufficiency (80 patients). Median ICU LOS was 1 day (range, 1-55 days). Patients surviving their hospital admission had a mean APACHE II score of 11.5 (range, 2-37) compared to a mean of 21.2 (range, 13-44) for patients who died prior to hospital discharge (P < 0.001). The overall mortality rate was 12%. A substantial number of gynecological oncology patients will be admitted to the ICU following surgery. Patient outcomes are favorable if APACHE II scores are low and ICU LOS is short.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

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Outcomes of gynecologic oncology patients admitted to the intensive care unit following surgery: a university teaching hospital experience

Leath¹,

Kendrick²,

Numnum³

et al. 2006

International Journal of Gynecological Cancer

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“…Although this particular scale has been used in other series of patients with neoplasms, 11,12,20,21 the APACHE score has also been frequently used. 22 The APACHE score was not consistently documented in this cohort; as a result, we chose not to use it in our analysis of outcomes.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Intensive Care Unit Utilization in Gynecologic Oncology Surgery

Ruskin

Urban

Sherman

et al. 2011

International Journal of Gynecological Cancer

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“…Postoperative morbidity and mortality, especially in cancer patients, have been reviewed in a number of studies in the field of gynecology [1,2,3]. Morbidity after gynaecological surgery ranges from approximately 10% to 20%, whereas mortality is extremely rare [4,5,6].…”

Section: Introductionmentioning

confidence: 99%

Need for critical care in gynaecology: a population-based analysis

et al. 2002

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Correspondence: Seppo Heinonen, seppo.heinonen@kuh.fi IntroductionPostoperative morbidity and mortality, especially in cancer patients, have been reviewed in a number of studies in the field of gynecology [1][2][3]. Morbidity after gynaecological surgery ranges from approximately 10% to 20%, whereas mortality is extremely rare [4][5][6]. Clinical guidelines and recommendations based on the unusual events of patient death are of little importance in medical care of the general population, and therefore information on severe acute morbidity as evidenced by near-miss cases and utilisation of intensive care units (ICUs) may help to audit the quality of care in a more meaningful manner. Reports on the utilisation and outcomes of critical care services required in the management of all gynaecological patients are rare. The other side of the coin is that severe morbidity and the need for intensive care poorly reflect the long-term effects leading to mortality after discharge from hospital. As far as we are aware, studies of the need for intensive care in gynaecology have not been recently conducted in the Nordic countries, where patient care is organised by public health care units, and thus virtually all women receive modern care. This study was undertaken to APACHE II = Acute Physiological and Chronic Health Evaluation II; ICU = intensive care unit; IVF = in vitro fertilisation; TISS = Therapeutic Intervention Scoring System. AbstractIntroduction The purpose of this study was to note potential gynaecological risk factors leading to intensive care and to estimate the frequency, costs and outcome of management. Materials and methodsIn a cross-sectional study of intensive care admissions in Kuopio from March 1993 to December 2000, 23 consecutive gynaecological patients admitted to a mixed medicalsurgical intensive care unit (ICU) were followed. We recorded demographics, admitting diagnoses, scores on the Acute Physiological and Chronic Health Evaluation (APACHE) II, clinical outcome and treatment costs. Results The overall need for intensive care was 2.3 per 1000 women undergoing major surgery during the study period. Patients were 55.4 ± 16.9 (mean ± SD) years old, with a mean APACHE II score of 14.07 (± 5.57). The most common diagnoses at admission were postoperative haemorrhage (43%), infection (39%) and cardiovascular disease (30%). The duration of stay in the ICU was 4.97 (± 9.28) (range 1-42 ) days and the mortality within 6 months was 26%, although the mortality in the ICU was 0%. The total cost of intensive care was approximately US$7044 per patient. Conclusions Very few gynaecological patients develop complications requiring intensive care. The presence of gynaecological malignancy and pre-existing medical disorders are clinically useful predictors of eventual outcome, but many cases occur in women with a low risk and this implies that the risk is relevant to all procedures. Further research is needed to determine effective preventive approaches.

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Use of the APACHE II Scoring System to Determine Mortality of Gynecologic Oncology Patients in the Intensive Care Unit

Abstract: Elevated APACHE II scores are associated with mortality in acutely ill gynecologic oncology patients.

Cited by 29 publications

References 7 publications

Outcomes of gynecologic oncology patients admitted to the intensive care unit following surgery: a university teaching hospital experience

Outcomes of gynecologic oncology patients admitted to the intensive care unit following surgery: a university teaching hospital experience

Predictors of Intensive Care Unit Utilization in Gynecologic Oncology Surgery

Need for critical care in gynaecology: a population-based analysis

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