Risk factors and mortality after elective and emergent laparatomies for oncological procedures in 899 patients in the intensive care unit: a retrospective observational cohort study

BACKGROUND: Abdominal surgeries for cancer are associated with postoperative complications and mortality. A view of the success of anaesthetic, surgical and critical care can be gained by analyzing factors associated with mortality in patients admitted to intensive care units (ICUs). The objective of this study was to identify the postoperative mortality rate and the causes of perioperative death in high-risk patients after abdominal surgery for cancer. A secondary objective was to explore possible risk factors for death in scheduled and emergency surgeries, with a view to finding guidance on preventable risk factors. METHODS: An observational study, in a 12-bed surgical ICU of a tertiary hospital. Patients admitted after abdominal surgery for cancer to the ICU for more than 24 hours' care were included from January 1, 2008-December 31, 2009. Data were extracted from the minimum basic dataset. The main outcome considered was 90-day mortality. RESULTS: Of 899 patients included, 80 (8.9%) died. Seven died within 48 hours of surgery, 18 died between 2 and 7 days, and 55 died after 7 days. Non-survivors were older and had more respiratory comorbidity, chronic liver disease, metastasis, and underwent more palliative procedures. 112 patients underwent emergency surgery; mortality in these patients for resection surgery was 32.5%; in the 787 patients who underwent scheduled surgery, mortality was 4.7% for resection procedures. The estimated odds ratios (95% confidence interval) of preoperative patient factors in emergency surgery confirmed a negative association between survival and older age 0.96 (0.91-1), the presence of respiratory comorbidity 0.14 (0.02-0.77) and metastasis 0.18 (0.05-0.6). After scheduled surgery, survival was negatively associated with age 0.93 (0.90-0.96) and chronic liver disease 0.40 (0.17-0.91). Analysis of complications after emergency surgery also indicated a negative association with sepsis 0.03 (0.003-0.32), respiratory events 0.043 (0.011-0.17) and cardiac events 0.11 (0.027-0.45); after scheduled surgery, respiratory 0.03 (0.01-0.08) and cardiac 0.11 (0.02-0.45) events, renal failure 0.02 (0.006-0.14) and neurological events 0.06 (0.007-0.5). CONCLUSIONS: As most deaths occurred after discharge from the ICU, postoperative sepsis, respiratory and cardiac events should be watched carefully on the ward.