The impact of unexpected intensive care unit admission after cancer surgery on long-term symptom burden among older adults: a population-based longitudinal analysis.

Autor: Tillmann BW; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. Bourke.tillmann@sunnybrook.ca.; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue - Room D108, Toronto, ON, M4N 3M5, Canada. Bourke.tillmann@sunnybrook.ca.; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. Bourke.tillmann@sunnybrook.ca., Hallet J; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Surgery, University of Toronto, Toronto, ON, Canada.; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada., Sutradhar R; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada., Guttman MP; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Surgery, University of Toronto, Toronto, ON, Canada., Coburn N; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Surgery, University of Toronto, Toronto, ON, Canada.; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada., Chesney TR; Department of Surgery, University of Toronto, Toronto, ON, Canada.; Department of Surgery, Unity Health, Toronto, ON, Canada., Zuckerman J; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Surgery, University of Toronto, Toronto, ON, Canada., Mahar A; Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada., Chan WC; ICES, Toronto, ON, Canada., Haas B; Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada.; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue - Room D108, Toronto, ON, M4N 3M5, Canada.; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.; Department of Surgery, University of Toronto, Toronto, ON, Canada.; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.; ICES, Toronto, ON, Canada.; Clinical Evaluative Sciences, Sunnybrook Research Institute, Toronto, ON, Canada.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2023 Apr 25; Vol. 27 (1), pp. 162. Date of Electronic Publication: 2023 Apr 25.
DOI: 10.1186/s13054-023-04415-8
Abstrakt: Background: Older adults are at high-risk for a post-operative intensive care unit (ICU) admission, yet little is known about the impact of these admissions on quality of life. The objective of this study was to evaluate the impact of an unexpected post-operative ICU admission on the burden of cancer symptoms among older adults who underwent high-intensity cancer surgery and survived to hospital discharge.
Methods: We performed a population-based cohort study of older adults (age ≥ 70) who underwent high-intensity cancer surgery and survived to hospital discharge in Ontario, Canada (2007-2017). Using the Edmonton Symptom Assessment System (ESAS), a standardized tool that quantifies patient-reported physical, mental, and emotional symptoms, we described the burden of cancer symptoms during the year after surgery. Total symptom scores ≥ 40 indicated a moderate-to-severe symptom burden. Modified log-Poisson analysis was used to estimate the impact of an unexpected post-operative ICU admission (admission not related to routine monitoring) on the likelihood of experiencing a moderate-to-severe symptom burden during the year after surgery, accounting for potential confounders. We then used multivariable generalized linear mixed models to model symptom trajectories among patients with two or more ESAS assessments. A 10-point difference in total symptom scores was considered clinically significant.
Results: Among 16,560 patients (mean age 76.5 years; 43.4% female), 1,503 (9.1%) had an unexpected ICU admission. After accounting for baseline characteristics, patients with an unexcepted ICU admission were more likely to experience a moderate-to-severe symptom burden relative to those without an unexpected ICU admission (RR 1.64, 95% CI 1.31-2.05). Specifically, among patients with an unexcepted ICU admission the average probability of experiencing moderate-to-severe symptoms ranged from 6.9% (95 CI 5.8-8.3%) during the first month after surgery to 3.2% (95% CI 0.9-11.7%) at the end of the year. Among the 11,229 (67.8%) patients with multiple ESAS assessments, adjusted differences in total scores between patients with and without an unexpected ICU admission ranged from 2.0 to 5.7-points throughout the year (p < 0.001).
Conclusion: While unexpected ICU admissions are associated with a small increase in the likelihood of experiencing a moderate-to-severe symptom burden, most patients do not experience a high overall symptom burden during the year after surgery. These findings support the role of aggressive therapy among older adults after major surgery.
(© 2023. The Author(s).)
Databáze: MEDLINE
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