Intensive care unit (ICU) readmission after major lung resection: Prevalence, patterns, and mortality.

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.

CONCLUSION: 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.