Abstract
Objective
The aims of this study was to investigate factors associated with intensive care unit (ICU) admission and prognosis following surgical treatment of gynaecological malignancy.
Materials and Methods
This study was designed as a retrospective cohort analysis, which encompasses patients who were subjected to gynecologic oncological surgery and subsequently monitored in the ICU from December 1st, 2022, to December 1st, 2023.
Results
Data of 57 patients who underwent gynaecological oncological surgery and were admitted to ICU during the study period were analysed. Median age was 61.47 years, median body mass index 27 kg/m2, American Society of Anaesthesiologists score 3±2.5. The most common indication for ICU admission was haemodynamic instability with 73.6% (n=42), followed by respiratory failure with 15.7% (n=9) and other reasons. Charlson comorbidity index, lactate and base deficit levels were higher and albumin values were lower in patients with ICU stay of 3 days or more (p=0.04, p=0.004, p=0.034, p=0.025). Only 2 patients (3.5%) developed mortality during the study period.
Conclusion
The most common indication for ICU follow-up after elective gynaecological oncology surgery is hemodynamic instability with low ICU mortality and short length of stay in general.
Keywords: Comorbidities, gynecologic oncology surgery, intensive care unit
References
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71:209-49.
- Wang S, Zheng R, Li J, Zeng H, Li L, Chen R, et al. Global, regional, and national lifetime risks of developing and dying from gastrointestinal cancers in 185 countries: a population-based systematic analysis of GLOBOCAN. Lancet Gastroenterol Hepatol. 2024;9:229-37.
- Schwandt A, Andrews SJ, Fanning J. Prospective analysis of a fever evaluation algorithm after major gynecologic surgery. Am J Obstet Gynecol. 2001;184:1066-7.
- Dhanis J, Keidan N, Blake D, Rundle S, Strijker D, van Ham M, et al. Prehabilitation to Improve Outcomes of Patients with Gynaecological Cancer: A New Window of Opportunity? Cancers (Basel). 2022;14:3448.
- Heinonen S, Tyrväinen E, Penttinen J, Saarikoski S, Ruokonen E. Need for critical care in gynaecology: a population-based analysis. Crit Care. 2002;6:371-5.
- Namendys-Silva SA, González-Herrera MO, Texcocano-Becerra J, Herrera-Gómez A. Outcomes of critically ill gynecological cancer patients admitted to intensive care unit. Am J Hosp Palliat Care. 2013;30:7-11.
- Krawczyk P, Trojnarska D, Baran R, Lonc T, Swistek R, Tyszecki P, et al. Postoperative gynecologic oncology admissions to intensive care unit in the tertiary care center: an eight-year retrospective study. Ginekologia Polska. 2023;94:599-604.
- Abebe MM, Arefayne NR, Temesgen MM, Admass BA. Incidence and predictive factors associated with hemodynamic instability among adult surgical patients in the post-anesthesia care unit, 2021: A prospective follow up study. Ann Med Surg (Lond). 2022;74:103321.
- Reidy CM, Beach ML, Gallagher JD, Sites BD. Postoperative hemodynamic instability after simultaneous bilateral total knee arthroplasty. J Patient Saf. 2010;6:233-7.
- Summers C, Todd RS, Vercruysse GA, Moore FA. Acute Respiratory Failure. Perioperative Medicine. 2022:576-86.
- Canet J, Gallart L, Gomar C, Paluzie G, Valles J, Castillo J, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338-50.
- Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373-83.
- Zimmerman JE, Kramer AA. Outcome prediction in critical care: the Acute Physiology and Chronic Health Evaluation models. Curr Opin Crit Care. 2008;14:491-7.
- Brooks SE, Ahn J, Mullins CD, Baquet CR. Resources and use of the intensive care unit in patients who undergo surgery for ovarian carcinoma. Cancer. 2002;95:1457-62.
- Amir M, Shabot MM, Karlan BY. Surgical intensive care unit care after ovarian cancer surgery: an analysis of indications. Am J Obstet Gynecol. 1997;176:1389-93.
- Leath C, Kendrick J, Numnum T, Straughn J, Rocconi R, Sfakianos G, et al. Outcomes of gynecologic oncology patients admitted to the intensive care unit following surgery: A university teaching hospital experience. Int J Gynecol Cancer. 2006;16:1766-9.
- Ruskin R, Urban RR, Sherman AE, Chen L-l, Powell CB, Burkhardt DH, et al. Predictors of intensive care unit utilization in gynecologic oncology surgery. Int J Gynecol Cancer. 2011;21:1336-42.
- Thomakos N, Zacharakis D, Rodolakis A, Zagouri F, Papadimitriou CA, Bamias A, et al. Gynecologic oncology patients in the surgical high dependency unit: an analysis of indications. Arch Gynecol Obstet. 2014;290:335-9.
- Thomakos N, Prodromidou A, Haidopoulos D, Machairas N, Rodolakis A. Postoperative Admission in Critical Care Units Following Gynecologic Oncology Surgery: Outcomes Based on a Systematic Review and Authors' Recommendations. In Vivo. 2020;34:2201-2208.
- Momenimovahed Z, Tiznobaik A, Taheri S, Salehiniya H. Ovarian cancer in the world: epidemiology and risk factors. Int J Womens Health. 2019;11:287-99.
- Abbas FM, Sert MB, Rosenshein NB, Zahyrak ML, Currie JL. Gynecologic oncology patients in the surgical ICU. Impact on outcome. J Reprod Med. 1997;42:173-8.
- Van Le L, Fakhry S, Walton LA, Moore DH, Fowler WC, Rutledge R. Use of the APACHE II scoring system to determine mortality of gynecologic oncology patients in the intensive care unit. Obstet Gynecol. 1995;85:53-6.
- Hallqvist L, Granath F, Fored M, Bell M. Intraoperative Hypotension and Myocardial Infarction Development Among High-Risk Patients Undergoing Noncardiac Surgery: A Nested Case-Control Study. Anesth Analg. 2021;133:6-15.
- Díaz-Montes TP, Zahurak ML, Bristow RE. Predictors of extended intensive care unit resource utilization following surgery for ovarian cancer. Gynecol Oncol. 2007;107:464-8.
Copyright and license
Copyright © 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.