USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA.
Urol Oncol. 2019 Sep;37(9):572.e13-572.e19. doi: 10.1016/j.urolonc.2019.06.019. Epub 2019 Jul 18.
To characterize drivers of ICU admission during index hospitalization after Radical Cystectomy (RC) with Enhanced Recovery After Surgery (ERAS) protocol, as well as corresponding outcomes.
A retrospective review of an IRB-approved cystectomy database was conducted. All patients who underwent RC with ERAS protocol from 2012 to 2017 were included.
adjunct nephrectomy or urethrectomy.
A total of 512 patients were identified. ICU admission in index hospitalization was reported in 33 patients (6.4%), 26 with unplanned ICU transfer after initial non-ICU level of care and 7 with planned direct postoperative ICU admission. Higher age and Charlson Comorbidity Index ≥3 were significant risk factors for unplanned ICU admission. On multivariate analysis, age remained associated (odds ratio 1.05, 95% confidence interval 1.008, 1.1, P = 0.02) and Charlson Comorbidity Index ≥3 kept the trend (odds ratio 2.16, 95% confidence interval 0.86 - 5.07, P = 0.08) with this increased risk of ICU admission. Patients in the unplanned ICU group spent a median of 3 days (range: 0-32) at non-ICU level of care before ICU transfer; cardiac indications were the most common reason for transfer (52%). Patients who required unplanned ICU transfer had a median length of stay of 11.5 days, compared to a length of stay of 5 days (P < 0.01) for non-ICU patients. Ninety-day readmission and mortality rates were higher in the planned ICU cohort when compared to the unplanned ICU cohort. A low rate of ICU admission (2.7%) in the corresponding 90-day postoperative period was reported for the group not requiring ICU admission during index hospitalization.
ICU admission is uncommon following RC with ERAS protocol. Advanced age and comorbidity index are significantly associated with unplanned ICU transfer. Planned ICU admissions are not shown to be associated with improved outcomes compared to unplanned ICU admissions. Further efforts to elucidate the role of ICU care in the context of the ERAS protocol is important for targeted care optimization and appropriate postoperative planning.
描述接受根治性膀胱切除术（RC）和加速康复外科（ERAS）方案后的住院期间入住 ICU 的驱动因素，并评估相应的结局。
对一项经过机构审查委员会批准的膀胱切除术数据库进行回顾性分析。纳入所有 2012 年至 2017 年间接受 RC 和 ERAS 方案治疗的患者。
辅助性肾切除术或尿道切除术。
共纳入 512 例患者。33 例（6.4%）患者在住院期间需要入住 ICU，其中 26 例患者初始在非 ICU 级护理水平下进行治疗，但之后转入 ICU，7 例患者计划直接术后转入 ICU。高龄和Charlson 合并症指数≥3 是 ICU 非计划性入住的显著危险因素。多变量分析显示，年龄仍然与 ICU 入住相关（优势比 1.05，95%置信区间 1.008，1.1，P=0.02），Charlson 合并症指数≥3 也有这种趋势（优势比 2.16，95%置信区间 0.86-5.07，P=0.08），提示 ICU 入住风险增加。非计划性 ICU 组的患者在转入 ICU 前在非 ICU 级护理水平的中位时间为 3 天（范围：0-32 天）；心脏指征是最常见的转科原因（52%）。需要非计划性 ICU 转科的患者的中位住院时间为 11.5 天，而非 ICU 患者的中位住院时间为 5 天（P＜0.01）。与非计划性 ICU 组相比，计划性 ICU 组的 90 天再入院率和死亡率更高。在住院期间不需要 ICU 治疗的患者，在相应的 90 天术后期间，ICU 入住率较低（2.7%）。
RC 接受 ERAS 方案治疗后，入住 ICU 的情况并不常见。高龄和合并症指数与 ICU 非计划性转科显著相关。与非计划性 ICU 入住相比，计划性 ICU 入住并不能改善结局。进一步阐明 ICU 护理在 ERAS 方案背景下的作用对于有针对性的护理优化和适当的术后规划非常重要。
