title: Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality.
abstract: BACKGROUND
  The aim of this study was to identify risk factors associated with mortality in patients re-admitted to an intensive care unit (ICU) after initial recovery from major lung resection.
  
  
  METHODS
  We retrospectively reviewed the case records of all patients who underwent major lung resection between February 2011 and May 2013. A total of 1916 patients underwent major resection surgery for various lung diseases, 63 (3.3%) of which required ICU admission after initial recovery. We analyzed preoperative and perioperative data, including ICU factors and outcomes.
  
  
  RESULTS
  The patient group included 57 men (90.5%) with a mean age of 65.3 years. Pathologic diagnosis was malignancy in 92.1% of patients, while 7.9% had benign disease. Open thoracotomy was performed in 84.1%, whereas minimally invasive approaches were performed in 15.9%. In-hospital mortality occurred in 16 (25.4%) patients. Patients were classified as either survivors (n = 47, 74.6%) or non-survivors (n = 16, 25.4%). The most common reason for ICU readmission was pulmonary complication (n = 50, 79.4%). Thirty-one patients (49.2%) required mechanical ventilation, seven (11.1%) required extracorporeal membrane oxygenation, and three (4.8%) required renal support. Multivariate analysis showed that acute respiratory distress syndrome (ARDS) and delirium were independent risk factors for in-hospital mortality. In addition, delirium frequently occurred in patients with ARDS.
  
  
  CONCLUSIONS
  ARDS and delirium were independent risk factors for in-hospital mortality in patients who were readmitted to the ICU after major lung resection. Future studies are needed to determine if the prevention of delirium and ARDS can improve postoperative outcomes for patients with lung cancer.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Tae Hee
authors.initials: TH
authors.lastname: Hong
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Hong Kwan
authors.initials: HK
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Yong Soo
authors.initials: YS
authors.lastname: Choi
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jhingook
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Young Mog
authors.initials: YM
authors.lastname: Shim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jae Ill
authors.initials: JI
authors.lastname: Zo
mesh_terms: D000368:Aged; D003693:Delirium / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008171:Lung Diseases / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D012128:Respiratory Distress Syndrome / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data; D013908:Thoracotomy / Q000706:statistics & numerical data*
keywords: 
  ARDS (acute respiratory distress syndrome); delirium; intensive care unit (ICU)