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A Population-Based Analysis of Long-Term Outcomes Among Older Adults Requiring Unexpected Intensive Care Unit Admission After Cancer Surgery

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

A Correction to this article was published on 24 November 2021

This article has been updated

Abstract

Background

High-intensity cancer surgery is increasingly common among older adults. However, these patients are at high-risk for unexpected intensive care unit (ICU) admissions after surgery. How these admissions impact older adults’ long-term outcomes is unknown.

Methods

We performed a population-based, cohort study of older adults (age ≥ 70 years) who underwent high-intensity cancer surgery from 2007 to 2017. Analyses were performed to examine time alive and at home following surgery, defined as time from surgery to nursing home admission or death. Patients were followed for up to 5 years. Extended Cox proportional hazards models examined the independent association between unexpected ICU admission (ICU admissions excluding routine postoperative monitoring) and remaining alive and at home. Subgroup analysis stratified patients by duration of mechanical ventilation (MV).

Results

Of 47,367 identified older adults, 7372 (15.6%) had an unexpected ICU admission. Patients with an unexpected ICU admission had a significantly lower probability of being alive and at home at 5 years (26.2%; 95% confidence interval [CI] 25.1–27.2%) compared with those without an unexpected admission (56.8%; 95% CI 56.3–57.4%). After adjusting for baseline characteristics, unexpected ICU admission remained associated with less time alive and at home. The elevated risk of death or nursing home admission persisted for 5 years after surgery (years 2–5: hazard ratio [HR] 1.58, 95% CI 1.50–1.66). Duration of MV was inversely associated with time alive and at home.

Conclusions

Older adults with an unexpected ICU admission after high-intensity cancer surgery are at increased risk for death or admission to a nursing home for at least 5 years.

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Acknowledgment

This study was funded by the Sunnybrook AFP Innovation Fund and the Ontario Institute for Cancer Research (P.HSR.156). This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). Parts of this material are based on data and/or information compiled and provided by CIHI. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding or data sources; no endorsement is intended or should be inferred.

Members of the RESTORE-C group

Amy Hsu, PhD and Douglas Manuel, MD, Ottawa Hospital Research Institute, Ottawa, Ontario; Frances Wright, MD, Dov Gandell, MD, and Ines Menjak, MD, Sunnybrook Health Sciences Centre, Toronto, Ontario; Lesley Gotlib-Conn, PhD, Sunnybrook Research Institute, Toronto, Ontario; Grace Paladino, patient and family advisor; Pietro Galuzzo, patient and family advisor.

Funding

This study was funded by the Sunnybrook AFP Innovation Fund and the Ontario Institute for Cancer Research (P.HSR.156).

Author information

Authors and Affiliations

  1. Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada

    Bourke W. Tillmann MD & Barbara Haas MD

  2. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Bourke W. Tillmann MD & Barbara Haas MD

  3. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

    Bourke W. Tillmann MD, Julie Hallet MD, Matthew P. Guttman MD, Natalie Coburn MD, Jesse Zuckerman MD & Barbara Haas MD

  4. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Julie Hallet MD, Matthew P. Guttman MD, Natalie Coburn MD, Tyler Chesney MD, Jesse Zuckerman MD & Barbara Haas MD

  5. Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Julie Hallet MD, Natalie Coburn MD & Barbara Haas MD

  6. ICES, Toronto, ON, Canada

    Julie Hallet MD, Natalie Coburn MD, Wing C. Chan MPH & Barbara Haas MD

  7. Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada

    Julie Hallet MD, Natalie Coburn MD, Victoria Zuk MHSc & Barbara Haas MD

  8. Department of Surgery, Unity Health, Toronto, ON, Canada

    Tyler Chesney MD

  9. Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada

    Alyson Mahar PhD

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  1. Bourke W. Tillmann MD
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and members of the REcovery after Surgical Therapy for Older adults Research—Cancer (RESTORE-C) group

  • Amy Hsu
  • , Douglas Manuel
  • , Frances Wright
  • , Dov Gandell
  • , Ines Menjak
  • , Lesley Gotlib-Conn
  • , Grace Paladino
  •  & Pietro Galuzzo

Corresponding author

Correspondence to Bourke W. Tillmann MD.

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Disclosures

JH has received speaking honoraria from Ipsen Biopharmaceuticals Canada, Novartis Oncology, and Advanced Accelerator Applications. NC receives salary support from Cancer Care Ontario as Lead for Patient-Reported Outcomes, and an honorarium from Astra-Zeneca.

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Work performed at ICES, Toronto, Ontario, Canada and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

The original online version of this article was revised: Wing C. Chan's family name was corrected.

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Tillmann, B.W., Hallet, J., Guttman, M.P. et al. A Population-Based Analysis of Long-Term Outcomes Among Older Adults Requiring Unexpected Intensive Care Unit Admission After Cancer Surgery. Ann Surg Oncol 28, 7014–7024 (2021). https://doi.org/10.1245/s10434-021-10705-8

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