Intensive care unit utilization and outcome after esophagectomy.
OBJECTIVE
To establish the frequency of intensive care unit (ICU) admission after esophagectomy and to determine the associated outcomes.


METHODS
Retrospective cohort study.


METHODS
Tertiary referral center.


METHODS
Four hundred thirty-two patients who underwent esophagectomy between January 2000 and June 2004.


METHODS
None


RESULTS
Data relating to demographics, patient co-morbidities, perioperative management, complications, and Acute Physiology and Chronic Health Evaluation (APACHE) III variables were abstracted. Statistical analyses were performed to compare survivors with non-survivors and ICU patients with non-ICU patients. Of 432 patients included in the study, 123 (28.5%) were admitted to the ICU. Arrhythmias, new infiltrates on chest radiograph, and documented aspiration were common reasons for ICU admission. Patients admitted to ICU were of high acuity (mean APACHE III score 54.5, mean prediction of ICU death 6.4%). Of 352 patients originally not sent to the ICU, 43 (12.2%) were subsequently admitted to the ICU, often for aspiration. Overall in-hospital mortality was 3.7% (16 of 432 patients). Fifteen of the 123 ICU patients (12.2%) did not survive to hospital discharge.


CONCLUSIONS
A significant minority of patients will require ICU admission after esophagectomy, often for aspiration pneumonitis and arrhythmias. Despite high severity of illness scores, the perioperative mortality rate for patients after esophagectomy at a high-volume center is low.
Iscimen
Remzi
R
Faculty of Medicine, Uludag University, Bursa, Turkey.
Brown
Daniel R
DR
Cassivi
Stephen D
SD
Keegan
Mark T
MT
D018806:APACHE; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology; D015331:Cohort Studies; D016208:Databases, Factual; D016629:Esophagectomy / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome