Unplanned intensive care unit admission after elective colon cancer resection: population-based registry study

The incidence, aetiology, and outcome of unplanned intensive care unit admission after elective colon cancer surgery remain unclear. This study investigated the incidence of, and factors associated with, unplanned intensive care unit admission following elective colon cancer resection in Sweden.

This nationwide retrospective registry study included adult patients undergoing elective colon cancer resection with curative intent in Sweden between 2010 and 2019. Patients with distant metastases, or rectal or appendiceal tumours were excluded. Data from the Swedish Colorectal Cancer Registry and the Swedish Intensive Care Registry were analysed. Patients not requiring intensive care unit admission served as controls.

Of 23 891 patients, 1343 (5.6%) required unplanned intensive care unit admission. These patients were older, had more co-morbidities, and were more likely to undergo open surgery and receive permanent stomas. Patients requiring surgical reintervention accounted for 43% of intensive care unit admissions and were identified later (day 5 versus day 1), had longer duration of stay in the intensive care unit (3 versus 1 day), and had worse outcomes than those with non-surgical complications, despite being younger, with less co-morbidity. Intensive care unit admission was linked to a higher unadjusted mortality rate at 30 days (13.9 versus 0.6%), 1 year (24.2 versus 4.6%), and 3 years (40.0 versus 15.3%). Laparoscopic surgery was associated with reduced intensive care unit admissions (odds ratio 0.59, 95% confidence interval 0.50 to 0.69) and lower 3-year mortality (odds ratio 0.79, 0.72 to 0.86), even after adjusting for patient- and surgery-related factors.

Unplanned intensive care unit admission was associated with increased short- and long-term mortality. Patients who had surgical reinterventions leading to intensive care unit admission were admitted later and had poorer outcomes than those with non-surgical complications, highlighting the need for earlier recognition and tailored postoperative monitoring strategies.