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Elective intensive care after lung resection: a multicentric propensity-matched comparison of outcome

^a Unit of Thoracic Surgery ‘Umberto I’ Regional Hospital Ancona, Italy
^b Unit of Thoracic Surgery, ‘Bellaria’ Hospital Bologna, Italy
^c Anaesthesiology and Intensive Care Unit ‘Bellaria’ Hospital Bologna, Italy

*Corresponding author: Dr A. Brunelli, Via S. Margherita 23, Ancona 60129, Italy. Tel.: +39 0715964439; fax: +39 0715964433.

E-mail address: alexit2000{at}yahoo.com (A. Brunelli).

The study was aimed at assessing the influence of the elective ICU admission on the early outcome after major lung resection by analyzing the different postoperative management policies of two centers. Center A managed all patients in a dedicated ward, resorting to ICU for complications requiring invasive assisted ventilation. In center B, high-risk patients were electively transferred to ICU immediately after operation. Propensity score was used to match those patients of center B electively admitted to ICU (96 of 157), with counterparts from center A (96 of 205). The outcome of these matched pairs were then compared. There was a trend of reduced total morbidity (23% vs. 35%, respectively; P=0.06), cardiovascular (13.5% vs. 23%, respectively; P=0.09) and pulmonary complication rates (9.3% vs. 18%, respectively; P=0.09), but a longer postoperative hospital stay (11.5 vs. 9.7, respectively; P=0.015) in the patients electively admitted to ICU, compared to matched center A patients. Mortality rates were not different (7.3% vs. 7.3%; P=1). Since the elective postoperative ICU admission did not show a clear-cut outcome benefit over the management in a dedicated ward, this practice should be limited to highly selected patients in order to efficiently utilize the available resources.

Key Words: Lung resection; Outcome; Intensive care management; Postoperative management; Morbidity; Mortality