Two Decades of ICU Utilization and Hospital Outcomes in a Comprehensive Cancer Center. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Wallace, Susannah K.; Rathi, Nisha K.; Waller, Dorothy K.; Ensor, Joe E.; Haque, Sajid A.; Price, Kristen J.; Piller, Linda B.; Tilley, Barbara C.; Nates, Joseph L.
• Is Part Of: Critical care medicine. Volume 44:Issue 5(2016)
• Publication Date: 2016-05
• Subjects: cancer -- critically ill -- intensive care unit -- intensive care unit utilization -- outcome -- oncologic; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000001568
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objective: To investigate ICU utilization and hospital outcomes of oncological patients admitted to a comprehensive cancer center. Design: Observational cohort study. Setting: The University of Texas MD Anderson Cancer Center. Patients: Consecutive adults with cancer discharged over a 20-year period. Interventions: None. Measurements and Main Results: The Cochran-Armitage test for trend was used to evaluate ICU utilization and hospital mortality rates by primary service over time. A negative binomial log linear regression model was fitted to the data to investigate length of stay over time. Among 387, 306 adult hospitalized patients, the ICU utilization rate was 12.9%. The overall hospital mortality rate was 3.6%: 16.2% among patients with an ICU stay and 1.8% among non-ICU patients. Among those admitted to the ICU, the mean (SD) admission Sequential Organ Failure Assessment score was 6.1 (3.8) for all ICU patients: 7.3 (4.4) for medical ICU patients and 4.9 (2.8) for surgical ICU patients. Hematologic disorders were associated with the highest hospital mortality rate in ICU patients (42.8%); metastatic disease had the highest mortality rate in non-ICU patients (4.2%); sepsis, pneumonia, and other infections had the highest mortality rate for all inpatients (8.5%). Conclusions: This study provides a longitudinal view of ICU utilization rates, hospital and ICU length of stay, and severity-adjusted mortality rates. Although the data arise from a single institution, it encompasses a large number of hospital admissions over two decades and can serve as a point of comparison for future oncological studies at similar institutions. More studies of this nature are needed to determine whether consolidation of cancer care into specialized large-volume facilities may improve outcomes, while simultaneously sustaining appropriate resource utilization and reducing unnecessary healthcare costs.