Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs. Methods: This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality. Results: Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU. Conclusions: Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.
Abstract
Background: In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs. Methods: This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality. Results: Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU. Conclusions: Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.
참고문헌 (33)
- De Angelis R, "Cancer survival in Europe 1999-2007 by country and age : results of EUROCARE : 5-a population-based study", Lancet Oncol, 15, pp.23~34 (2014)
- van der Zee EN, "One-year mortality of cancer patients with an unplanned ICU admission : a cohort analysis between 2008 and 2017 in the Netherlands", J Intensive Care Med, 37, pp.1165~1173 (2022)
- Azoulay E, "The Intensive Care Medicine research agenda on critically ill oncology and hematology patients", Intensive Care Med, 43, pp.1366~1382 (2017)
- Soares M, "Characteristics and outcomes of patients with cancer requiring admission to intensive care units : a prospective multicenter study", Crit Care Med, 38, pp.9~15 (2010)
- Bos MM, "Outcomes of cancer patients after unplanned admission to general intensive care units", Acta Oncol, 51, pp.897~905 (2012)
- Donovan AL, "Interprofessional care and teamwork in the ICU", Crit Care Med, 46, pp.980~990 (2018)
- Penoyer DA, "Nurse staffing and patient outcomes in critical care : a concise review", Crit Care Med, 38, pp.1521~1528 (2010)
- Banerjee R, "Economic implications of nighttime attending intensivist coverage in a medical intensive care unit", Crit Care Med, 39, pp.1257~1262 (2011)
- van der Sluis FJ, "The impact of open versus closed format ICU admission practices on the outcome of high risk surgical patients : a cohort analysis", BMC Surg, 11, pp.18~ (2011)
- Gajic O, "Effect of 24-hour mandatory versus on-demand critical care specialist presence on quality of care and family and provider satisfaction in the intensive care unit of a teaching hospital", Crit Care Med, 36, pp.36~44 (2008)
- Nawaz FA, "Critical care practices in the world : results of the global intensive care unit need assessment survey 2020", World J Crit Care Med, 11, pp.169~177 (2022)
- Sakr Y, "The impact of hospital and ICU organizational factors on outcome in critically ill patients : results from the Extended Prevalence of Infection in Intensive Care study", Crit Care Med, 43, pp.519~526 (2015)
- Yang Q, "Mortality rate and other clinical features observed in Open vs closed format intensive care units: a systematic review and meta-analysis", Medicine (Baltimore), 98, pp.e16261~ (2019)
- Hackner D, "Do faculty intensivists have better outcomes when caring for patients directly in a closed ICU versus consulting in an open ICU?", Hosp Pract(1995), 37, pp.40~50 (2009)
- Mayumi T, "The practice guidelines for primary care of acute abdomen 2015", Jpn J Radiol, 34, pp.80~115 (2016)
- Amin MB, "AJCC cancer staging manual" (2017), Springer
- Gharipour A, "The incidence and outcome of severe hyperlactatemia in critically ill patients", Intern Emerg Med, 16, pp.115~123 (2021)
- Kelly FE, "Intensive care medicine is 60 years old : the history and future of the intensive care unit", Clin Med(Lond), 14, pp.376~379 (2014)
- Oh TK, "Trained intensivist coverage and survival outcomes in critically ill patients : a nationwide cohort study in South Korea", Ann Intensive Care, 13, pp.4~ (2023)
- Cullati S, "Internists' and intensivists' roles in intensive care admission decisions : a qualitative study", BMC Health Serv Res, 18, pp.620~ (2018)
- Coccolini F, "Acute abdomen in the immunocompromised patient : WSES, SIS-E, WSIS, AAST, and GAIS guidelines", World J Emerg Surg, 16, pp.40~ (2021)
- Kang MK, "Pre and postoperative lactate levels and lactate clearance in predicting in-hospital mortality after surgery for gastrointestinal perforation", BMC Surg, 22, pp.93~ (2022)
- Oedorf K, "Serum lactate predicts adverse outcomes in emergency department patients with and without infection", West J Emerg Med, 18, pp.258~266 (2017)
- Spiegelberg J, "Severe hyperlactatemia in unselected surgical patients : retrospective analysis of prognostic outcome factors", BMC Surg, 22, pp.312~ (2022)
- Freire Jorge P, "The association of early combined lactate and glucose levels with subsequent renal and liver dysfunction and hospital mortality in critically ill patients", Crit Care, 21, pp.218~ (2017)
- Wiggans MG, "Serum arterial lactate concentration predicts mortality and organ dysfunction following liver resection", Perioper Med(Lond), 2, pp.21~ (2013)
- Jung YT, "Addition of lactic acid levels improves the accuracy of quick sequential organ failure assessment in predicting mortality in surgical patients with complicated intra-abdominal infections : a retrospective study", World J Emerg Surg, 13, pp.14~ (2018)
- White KC, "Sepsis-associated acute kidney injury in the intensive care unit: incidence, patient characteristics, timing, trajectory, treatment, and associated outcomes. A multicenter, observational study", Intensive Care Med, 49, pp.1079~1089 (2023)
- Wang Z, "The association between continuous renal replacement therapy as treatment for sepsis-associated acute kidney injury and trend of lactate trajectory as risk factor of 28-day mortality in intensive care units", BMC Emerg Med, 22, pp.32~ (2022)
- Kim DW, "Hospital mortality and prognostic factors in critically ill patients with acute kidney injury and cancer undergoing continuous renal replacement therapy", Kidney Res Clin Pract, 41, pp.717~729 (2022)
- Druml W, "Association of acute kidney injury receiving kidney replacement therapy with prognosis of critically ill patients with and without cancer : a retrospective study", Crit Care Med, 49, pp.1932~1942 (2021)
- Lavanchy JL, "Impact of inter-hospital transfer on outcomes in patients undergoing emergency abdominal surgery : a tertiary referral center's perspective", World J Surg, 45, pp.2703~2711 (2021)
- Kokotovic D, "Acute abdominal pain and emergency laparotomy : bundles of care to improve patient outcomes", Br J Surg, 110, pp.1594~1596 (2023)