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Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway.

Publication ,  Journal Article
Cheng, KW; Shah, A; Bazargani, S; Miranda, G; Cai, J; Aron, M; Schuckman, A; Desai, M; Gill, I; Daneshmand, S; Djaladat, H
Published in: Urol Oncol
September 2019

PURPOSE: To characterize drivers of ICU admission during index hospitalization after Radical Cystectomy (RC) with Enhanced Recovery After Surgery (ERAS) protocol, as well as corresponding outcomes. METHODS: A retrospective review of an IRB-approved cystectomy database was conducted. All patients who underwent RC with ERAS protocol from 2012 to 2017 were included. EXCLUSION CRITERIA: adjunct nephrectomy or urethrectomy. RESULTS: A total of 512 patients were identified. ICU admission in index hospitalization was reported in 33 patients (6.4%), 26 with unplanned ICU transfer after initial non-ICU level of care and 7 with planned direct postoperative ICU admission. Higher age and Charlson Comorbidity Index ≥3 were significant risk factors for unplanned ICU admission. On multivariate analysis, age remained associated (odds ratio 1.05, 95% confidence interval 1.008, 1.1, P = 0.02) and Charlson Comorbidity Index ≥3 kept the trend (odds ratio 2.16, 95% confidence interval 0.86 - 5.07, P = 0.08) with this increased risk of ICU admission. Patients in the unplanned ICU group spent a median of 3 days (range: 0-32) at non-ICU level of care before ICU transfer; cardiac indications were the most common reason for transfer (52%). Patients who required unplanned ICU transfer had a median length of stay of 11.5 days, compared to a length of stay of 5 days (P < 0.01) for non-ICU patients. Ninety-day readmission and mortality rates were higher in the planned ICU cohort when compared to the unplanned ICU cohort. A low rate of ICU admission (2.7%) in the corresponding 90-day postoperative period was reported for the group not requiring ICU admission during index hospitalization. CONCLUSION: ICU admission is uncommon following RC with ERAS protocol. Advanced age and comorbidity index are significantly associated with unplanned ICU transfer. Planned ICU admissions are not shown to be associated with improved outcomes compared to unplanned ICU admissions. Further efforts to elucidate the role of ICU care in the context of the ERAS protocol is important for targeted care optimization and appropriate postoperative planning.

Duke Scholars

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Published In

Urol Oncol

DOI

EISSN

1873-2496

Publication Date

September 2019

Volume

37

Issue

9

Start / End Page

572.e13 / 572.e19

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Risk Factors
  • Retrospective Studies
  • Prospective Studies
  • Patient Admission
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Cheng, K. W., Shah, A., Bazargani, S., Miranda, G., Cai, J., Aron, M., … Djaladat, H. (2019). Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway. Urol Oncol, 37(9), 572.e13-572.e19. https://doi.org/10.1016/j.urolonc.2019.06.019
Cheng, Kai W., Ankeet Shah, Soroush Bazargani, Gus Miranda, Jie Cai, Monish Aron, Anne Schuckman, et al. “Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway.Urol Oncol 37, no. 9 (September 2019): 572.e13-572.e19. https://doi.org/10.1016/j.urolonc.2019.06.019.
Cheng KW, Shah A, Bazargani S, Miranda G, Cai J, Aron M, et al. Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway. Urol Oncol. 2019 Sep;37(9):572.e13-572.e19.
Cheng, Kai W., et al. “Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway.Urol Oncol, vol. 37, no. 9, Sept. 2019, pp. 572.e13-572.e19. Pubmed, doi:10.1016/j.urolonc.2019.06.019.
Cheng KW, Shah A, Bazargani S, Miranda G, Cai J, Aron M, Schuckman A, Desai M, Gill I, Daneshmand S, Djaladat H. Factors influencing ICU admission and associated outcome in patients undergoing radical cystectomy with enhanced recovery pathway. Urol Oncol. 2019 Sep;37(9):572.e13-572.e19.
Journal cover image

Published In

Urol Oncol

DOI

EISSN

1873-2496

Publication Date

September 2019

Volume

37

Issue

9

Start / End Page

572.e13 / 572.e19

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Risk Factors
  • Retrospective Studies
  • Prospective Studies
  • Patient Admission
  • Middle Aged
  • Male
  • Intensive Care Units
  • Humans
  • Female