Do pneumonectomy and oesophagectomy patients survive after admission into an Intensive Care Unit?

Pneumonectomy and oesophagectomy have among the highest postoperative 30-day mortality rates with overall mortality of about 10%. Respiratory complications make the largest contribution to poor outcome and admission into an ICU is usually required. There has been a lack of information on outcome in these patients. The aim of this study was to provide information on the overall and comparative outcomes in a regional thoracic centre. This is a retrospective case review study. The data were collected from the Intensive Care National Audit and Research Centre (ICNARC), the hospital's Performance Management Unit and the medical records of 204 patients who underwent pneumonectomy (n = 122) and oesophagectomy (n = 82) between Feb. 1996 and Aug. 2001. Mann-Whitney U test, χ test and logistic regression were used for statistical analysis. A value of p < 0.05 was considered significant. During the study period 31% of pneumonectomy patients and 26% of oesophagectomy patients were admitted to ICU. After oesophagectomy APACHE II score on admission was higher (median [IQR] 18.5 [12–37] v. 16 [11–21]; p = 0.001), ICU stay was longer (3 [2–10] v. 2.5 [0.8–6.3] days; p = 0.001) and costs higher (£3 [2–6] k v. £2 [0.8–5.7] k per patient; p = 0.001) than after pneumonectomy (Table 1). However, ICU mortality was higher after pneumonectomy (41.8%v. 26.8%) though this did not reach statistical significance (p = 0.06). In both groups, 78% of deaths were during mechanical ventilation within the first 24 h of admission. Ventilation within the first 24 h increased ICU mortality from 26.8% to 35.4% (OR 3.2 (95%CI 1.0–9.7)) after oesophagectomy, and increased ICU mortality from 41.8% to 50.6% (OR 3.0 (95%CI 1.3–6.7)) after pneumonectomy. APACHE II may be useful to predict ICU mortality in these groups of patients and could be used to guide clinicians in admitting patients earlier to improve outcome.