Rate and Factors Related to Postoperative Intensive Care Unit (ICU) Utilization in Elective Gynecologic Oncology Patients

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Sirima Phoowanakulchai
Yamolpat Jirauraipong
Suneerat Kongsayreepong
Suwanit Therasakvichya
Patchareya Nivatpumin
Pawit Somnuke


Background: ICU has played an important role in taking care of patients scheduled for oncologic gynecology surgery; however, information regarding utilization of critical care services and the outcomes of these patients is not well established, particularly in Siriraj hospital. Most of these patients also have medical comorbidities, contributing to complications. Objective: To determine the rate and factors related to postoperative ICU admission among gynecologic oncology patients with the beforehand ICU reservations and to report the postoperative outcomes. Materials and Methods: The retrospective single-center study was conducted by reviewing patient charts from April 2013 to March 2020. Preoperative characteristics and intra-and postoperative events were analyzed using logistic regression analysis. Results: A total of 321 patients who underwent preoperative ICU reservation with complete medical records were collected. Most of the patients aged <65 years (62.3%) and had American Society of Anesthesiologists (ASA) physical status ≥ III (71.3%). Total confirmed postoperative ICU admissions were 90 cases (28%). Factors related to ICU admission included preoperative serum albumin level <3.45 g/dl, intraoperative blood loss >800 ml and urine output <0.5 ml/kg/h. Most common indication of ICU admission and postoperative complication were postoperative observation (48.9%) and acute kidney injury (AKI) (36.7%), respectively. Conclusion: Albeit low rate of gynecologic oncology patients requiring postoperative ICU admission, vigilant patient evaluation before ICU admission is paramount. This study provides predictors that can be implemented in future guideline for postoperative ICU admission to save the healthcare resources and preserve ICU space for the patients in need.

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