Intensive care unit admissions following lobectomy or sublobar resections for non-small cell lung cancer

• Published in: Laeknabladid Vol. 98; no. 5; pp. 271 - 275
• Main Authors: Axelsson, Tomas Andri, Sigurdsson, Martin Ingi, Alexandersson, Asgeir, Thorsteinsson, Hunbogi, Klemenzson, Gudmundur, Jonsson, Steinn, Gudbjartsson, Tomas
• Format: Journal Article
• Language: Icelandic
• Published: Iceland 01.05.2012
• Subjects: Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung - surgery; Female; Humans; Iceland; Intensive Care Units; Length of Stay; Lung Neoplasms - surgery; Male; Middle Aged; Patient Admission; Pneumonectomy - adverse effects; Postoperative Complications - etiology; Postoperative Complications - therapy; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Iceland
• ISSN: 0023-7213
• DOI: 10.17992/lbl.2012.05.431

Following resection for non-small cell lung cancer (NSCLC), patients are usually admitted to the post-anesthesia care unit (PACU)for a few hours before admission to a general ward (GW). However, some patients need ICU-admission, either immediately post-surgery or from the PACU or GW. The aim of this study was to investigate the indications and risk factors for ICU-admission. A retrospective study of 252 patients who underwent lobectomy, wedge resection or segmentectomy for NSCLC in Iceland during 2001-2010. Data was retrieved from medical records and patients admitted to the ICU compared to patients not admitted. Altogether 21 patients (8%) were admitted to the ICU, median length-of-stay being one day (range 1-68). In 11 cases (52%) the reasons for admission were intraoperative problems, usually hypotension or excessive bleeding. Ten patients were admitted from the GW (n=4) or PACU (n=6), due to hypotension (n=4), heart and/or respiratory failure (n=4) and reoperation for bleeding (n=2). There were three ICU-readmissions. Patients admitted to the ICU were six years older (p=0.004) and more often had chronic obstructive pulmonary disease and/or coronary artery disease. Tumor size, pTNM-stage, length of operation and the ratio of patients receiving TEA (thoracic epidural anaesthesia) were similar between groups. Over two-thirds of the ICU-patients had minor complications and around half had major complications, compared to 30% and 4%, respectively, for controls. ICU-admissions are infrequent following non-pneumonectomy lung resections for NSCLC, these patients being older with cardiopulmonary comorbidities. In half of the cases, admission to the ICU directly follows surgery and ICU-readmissions are few.