Abstract
Postoperative management after major lung surgery is critical. This study evaluates risk factors for predicting mandatory intensive care unit (ICU) admission immediately after major lung resection. We retrospectively reviewed patients for whom the surgeon requested an ICU bed before major lung resection surgery. Patients were classified into three groups. Univariable and multivariable logistic regression analyses were performed, and a clinical nomogram was constructed. Among 340 patients, 269, 50, and 21 were classified into the no need for ICU, mandatory ICU admission, and late-onset complication groups, respectively. Predictive postoperative diffusion capacity of the lung for carbon monoxide (47.2 (interquartile range (IQR) 43.3–65.7)% versus vs. 67.8 (57.1–79.7)%; p = 0.003, odds ratio (OR) 0.969, 95% confidence interval (CI) 0.95–0.99), intraoperative blood loss (400.00 (250.00–775.00) mL vs. 100.00 (50.00–250.00) mL; p = 0.040, OR 1.001, 95% CI 1.000–1.002), and open thoracotomy (p = 0.030, OR 2.794, 95% CI 1.11–7.07) were significant predictors for mandatory ICU admission. The risk estimation nomogram demonstrated good accuracy in estimating the risk of mandatory ICU admission (concordance index 83.53%). In order to predict the need for intensive care after major lung resection, preoperative and intraoperative factors need to be considered.
Highlights
Surgery-related mortality due to pulmonary resection is relatively low, but pulmonary resection can cause various complications such as intraoperative bleeding, arrhythmia, myocardial infarction, and respiratory failure [1,2]
Increased use of the intensive care unit (ICU) for surveillance purposes can lead to limited ICU resources; patients who require intensive care may be overlooked, and their conditions may worsen in general wards
The patients who were admitted to the ICU immediately postoperatively were classified into two groups: (1) ineffective use group: patients who were admitted to the ICU immediately postoperatively only for surveillance purposes and transferred to the general ward the day after the surgery and (2) effective use group: those who met the criteria of mandatory ICU admission
Summary
Surgery-related mortality due to pulmonary resection is relatively low, but pulmonary resection can cause various complications such as intraoperative bleeding, arrhythmia, myocardial infarction, and respiratory failure [1,2]. In most thoracic surgical centers, postoperative admission to an intensive care unit (ICU) is planned for patients who will be undergoing major lung resection, often only for surveillance purposes [3]. ICU admission only for surveillance is not desirable in terms of cost-effectiveness and could result in an overuse of ICU resources [3,4]. Increased use of the ICU for surveillance purposes can lead to limited ICU resources; patients who require intensive care may be overlooked, and their conditions may worsen in general wards. In recent years, studies have been performed to determine the risk factors for mandatory ICU admission after lung resection. Numerous factors, including age, pneumonectomy (versus [vs.] other types of lung resection), male sex, smoking, severe chronic obstructive pulmonary disease, severe restrictive lung disease (predicted forced vital capacity
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