Introduction: 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.

Material and methods: 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.

Results: 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.

Conclusion: 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.

Axelsson TA, Sigurdsson MI, Alexandersson A, Thorsteinsson H, Klemenzson G, Jonsson S, Gudbjartsson T

Faculty of Medicine, University of Iceland, Departments of Cardiothoracic Surgery, Anesthesia and Intensive Care and Pulmonology

Figure 1. Flow chart showing the patient cohort that  admitted to the ICU together with the control group (grey boxes).

Table I. Reasons for admission and information on patients admitted to the ICU.

Age/gender	ASA - score	pTNM-stage	Reason for admission	Length of stay (days)
Patients admitted to the ICU immediately after surgery
79/Male	2	IIA	Observation	3
73/Male	2	IV	Wound reopened and another lobe resected	68
78/Male	3	IA	Hypothermia	1
73/Male	3	IV	Hypotension	1
85/Female	2	IIA	Intraoperative bleeding	1
71/Male	3	IIB	Intraoperative bleeding	64
56/Male	3	IB	Difficult intubation	1
77/Male	3	IIB	Observation	1
60/Male	4	IA	Hypotension	1
73/Female	2	IIIA	Hypotension	1
79/Male	3	IA	Hypotension	11
Patients admitted to the ICU from the post-anesthesia care unit or the general ward
77/Male	4	IB	Reoperation for bleeding	1
71/Male	3	IA	Reoperation for bleeding	1
80/Female	3	IB	Heart and respiratory failure	16
59/Female	3	IB	Hypotension	1
84/Female	3	IIA	Heart failure	2
74/Female	3	IA	Hypotension	1
76/Male	3	IIA	Hypotension	1
79/Male	3	IA	Respiratory failure	13
62/Female	3	IIIA	Respiratory failure	4
78/Female	3	IA	Hypotension	4

 

Table II. Clinical information on patients, n (%).

	ICU group n=21	Control group n=231	p-value
Age	74±8	68± 10	0.004
Male	13 (62)	111 (48)	0.32
Smoking history	20 (95)	221 (96)	1
Chronic obstr. pulmonary disease	11 (52)	67 (29)	0.049
Coronary heart disease	11 (52)	67 (29)	0.049
History of arrhythmia	5 (24)	189 (32)	0.56
ASA score*
1	0 (0)	2 (1)	1
2	4 (19)	97 (42)	0.06
3	15 (71)	125 (54)	0.17
4	2 (10)	6 (3)	0.14
FEV1 < 75% of predicted value**	5 (24)	56 (24)	0.83
FVC < 80% of predicted value***	4 (19)	38 (17)	0.76
Tumor size (cm)	3.5 ± 2.1	2.8 ± 1.3	0.06
TMN-stage
I	11 (52)	130 (56)	0,91
II	6 (29)	61 (26)	0,83
III	2 (10)	32 (14)	0,82
IV	2 (10)	8 (4)	0,44

*American society of anesthesiologists

**Forced expiratory volume in 1 second. Lung function tests were missing for one patient.

***Forced vital capacity. Lung function tests were missing for one patient.

 

 

Table III. Postoperative complications and operative mortality in both groups, n (%).

Complications	ICU group n=21	Control group n=231	p-value
Minor complications	15 (71)	69 (30)	<0.001
Prolonged air leak (>7days)	9 (43)	39 (17)	0.008
Atrial fibrillation	5 (24)	42 (18)	0.56
Pneumonia	8 (38)	17 (7)	<0.001
Wound infection	1 (5)	6 (3)	0.46
Empyema	0 (0)	2 (1)	1
Paralysis of rec. laryngeal nerve	0 (0)	4 (2)	1
Major complications	10 (48)	10 (4)	<0.001
Acute respirat. distress syndrome	6 (29)	0 (0)	<0.001
Heart failure	4 (19)	4 (2)	0.002
Reoperation for bleeding	4 (19)	3 (1)	0.001
Myocardial infarct	1 (5)	3 (1)	0.3
Bronchopleural fistula	0 (0)	0 (0)
Superior vena cava syndrome	0 (0)	1 (1)	1
Mortality
<30 days	2 (10)	0 (0)	0,006
<90 days	3 (14)	1 (1)	0,002