Predictors of extended intensive care unit resource utilization following surgery for ovarian cancer

To identify perioperative variables associated with length of stay in the surgical intensive care unit (SICU), and overall cost of hospitalization in order to optimize resource utilization among patients undergoing surgery for ovarian cancer.

A retrospective analysis of patients admitted to the SICU immediately after surgery for ovarian cancer between 1/1/94 and 6/30/04 was performed. Patients admitted to the SICU were categorized in two groups. Those admitted for < 48 h were compared patients requiring a SICU stay > or = 48 h. Perioperative variables were compared across the two groups by univariate and multivariate logistic regression analysis.

A total of 95 patients were admitted to the SICU immediately after surgical management for ovarian cancer, with 57% requiring a stay > or = 48 h. Patient age = 63 years was associated with an increase risk of admission to the SICU for > or = 48 h (OR: 5.9, 95% CI: 1.72-20.50, p=0.005). Patients with administration of > or = 5 l of crystalloid solution during surgery were 8 times more likely to have prolonged admission to the SICU (95% CI: 2.34-27.57, p=0.001). Furthermore, a preoperative serum albumin level > or = 3.5 g/dl was associated with a reduction in the risk of prolonged admission to the SICU (OR: 0.23, 95% CI: 0.07-0.77, p=0.02). The average cost of hospitalization per patient was $33,086. Cost of hospital care was strongly associated with SICU length of stay (p=0.005).

Extensive fluid resuscitation during surgery, poor nutritional status, and > or = 63 years are associated with a prolonged postoperative SICU stay. These data may facilitate a reduction in unnecessary ICU admissions for patients without these risk factors and thereby optimize resource utilization following surgery for ovarian cancer.