Readmission to intensive care unit after initial recovery from major thoracic oncology surgery

Little has been published regarding outcomes subsequent to complications after thoracic surgery. The present study investigated outcomes and risk factors associated with mortality in patients admitted to an intensive care unit (ICU) after initial recovery from thoracic oncology surgery.

From March 2001 to August 2005, 1,087 patients underwent major resection for lung or esophageal cancer. Ninety-four (8.6%) of those patients required ICU care after initial recovery, and were the subject of the present retrospective review.

The patient group included 85 males (90.4%), of mean age 66 years. Patients were classified as either survivors (n = 63, 67%) or nonsurvivors (n = 31, 33%). The most common reason for ICU readmission was pulmonary complication (n = 73, 77.7%). Sixty-four patients (68.1%) required mechanical ventilation and 42 (43.3%) required renal support. Multivariate analysis showed that the initial acute physiological assessment and chronic health evaluation (APACHE) III score at readmission to ICU, duration of mechanical ventilation, and renal support were risk factors for in-hospital mortality. The overall three-year survival was 50.6%. Cox analysis showed that survivors who underwent tracheostomy had a poor prognosis (p = 0.011). Of 12 late mortalities in survivors who underwent tracheostomy, 9 (75%) were due to cancer-unrelated causes.

The ICU readmission after thoracic oncology surgery was associated with high in-hospital mortality. Identification of patients with a high APACHE score and (or) prolonged ventilation at readmission may help predict the risk of mortality. Preemptive strategies designed to optimize treatment of such high-risk patients may improve outcomes. Survivors from ICU readmission after thoracic oncology surgery require meticulous and frequent follow-up due to a high risk of deterioration after discharge.