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Post-intensive care unit syndrome in gynecologic oncology patients. Support Care Cancer 2016; 24:4627-32. [DOI: 10.1007/s00520-016-3305-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
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Curti BD, Longo DL. Intensive Care of the Cancer Patient. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Díaz-Montes TP, Zahurak ML, Bristow RE. Predictors of extended intensive care unit resource utilization following surgery for ovarian cancer. Gynecol Oncol 2007; 107:464-8. [PMID: 17765297 DOI: 10.1016/j.ygyno.2007.07.074] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 07/17/2007] [Accepted: 07/26/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify perioperative variables associated with length of stay in the surgical intensive care unit (SICU), and overall cost of hospitalization in order to optimize resource utilization among patients undergoing surgery for ovarian cancer. METHODS A retrospective analysis of patients admitted to the SICU immediately after surgery for ovarian cancer between 1/1/94 and 6/30/04 was performed. Patients admitted to the SICU were categorized in two groups. Those admitted for < 48 h were compared patients requiring a SICU stay > or = 48 h. Perioperative variables were compared across the two groups by univariate and multivariate logistic regression analysis. RESULTS A total of 95 patients were admitted to the SICU immediately after surgical management for ovarian cancer, with 57% requiring a stay > or = 48 h. Patient age = 63 years was associated with an increase risk of admission to the SICU for > or = 48 h (OR: 5.9, 95% CI: 1.72-20.50, p=0.005). Patients with administration of > or = 5 l of crystalloid solution during surgery were 8 times more likely to have prolonged admission to the SICU (95% CI: 2.34-27.57, p=0.001). Furthermore, a preoperative serum albumin level > or = 3.5 g/dl was associated with a reduction in the risk of prolonged admission to the SICU (OR: 0.23, 95% CI: 0.07-0.77, p=0.02). The average cost of hospitalization per patient was $33,086. Cost of hospital care was strongly associated with SICU length of stay (p=0.005). CONCLUSION Extensive fluid resuscitation during surgery, poor nutritional status, and > or = 63 years are associated with a prolonged postoperative SICU stay. These data may facilitate a reduction in unnecessary ICU admissions for patients without these risk factors and thereby optimize resource utilization following surgery for ovarian cancer.
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Affiliation(s)
- Teresa P Díaz-Montes
- The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, MD 21287, USA.
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Halpern NA, Pastores SM, Thaler HT, Greenstein RJ. Critical care medicine use and cost among Medicare beneficiaries 1995-2000: major discrepancies between two United States federal Medicare databases. Crit Care Med 2007; 35:692-9. [PMID: 17255850 DOI: 10.1097/01.ccm.0000257255.57899.5d] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A comparison of federal Medicare databases to identify critical care medicine (CCM) use, cost discrepancies, and their possible causes. DESIGN A 6-yr (1995-2000) retrospective analysis of Medicare hospital and CCM use and cost, comparing the Hospital Cost Report Information System (HCRIS) with Medicare Provider Analysis and Review File (MedPAR) supplemented when necessary by Health Care Information System (HCIS) (identified herein as MedPAR/HCIS). SETTING All nonfederal U.S. hospitals. SUBJECTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data are presented as days (M = million) and costs ($; B = Billion) for both hospitals and CCM. Between 1995 and 2000, the number of hospital days decreased in both databases: HCRIS (-13.2%; 78M to 67.7M) and MedPAR/HCIS (-14.1%; 82.8M to 71.1M). CCM days decreased in HCRIS (-4.6%; 8.3M to 7.9M). In contrast, CCM days increased in MedPAR/HCIS (7.2%; 13.9M to 14.9M). The discrepancy in CCM days between HCRIS and MedPAR/HCIS increased from 40% (5.6M days) in 1995 to 47% (7M days) in 2000. Two CCM billing codes (intensive care unit and coronary care unit "post/intermediate") used in MedPAR/HCIS were responsible for 73% on average per year, over the study period, for this CCM discrepancy. The use of these two codes progressively increased (44%; 3.9M to 5.6M days) by the end of the study. The cumulative 6-yr discrepancy in CCM days between HCRIS and MedPAR/HCIS (37.3M days) had a calculated cost of $92.3B. CONCLUSIONS We have identified major, and progressively increasing, discrepancies between two U.S. federal databases tabulating hospital and CCM use and cost for Medicare beneficiaries. Two CCM "post/intermediate" billing codes in MedPAR/HCIS were predominantly responsible for the CCM discrepancy. To accurately assess Medicare CCM use and cost, either HCRIS, or MedPAR/HCIS without the "post/intermediate" codes, should be used.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Fumis RRL, Nishimoto IN, Deheinzelin D. Measuring satisfaction in family members of critically ill cancer patients in Brazil. Intensive Care Med 2005; 32:124-8. [PMID: 16292625 DOI: 10.1007/s00134-005-2857-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the determinants for satisfaction of cancer patients' family members with the intensive care unit. DESIGN Prospective cohort study. SETTING A 13-bed intensive care unit in a tertiary cancer centre. PATIENTS AND PARTICIPANTS 164 families of consecutive patients with a length of stay greater than 48 h. INTERVENTION None. MEASUREMENT A modified version of the Critical Care Family Needs Inventory was applied and compared with the families' perception of prognosis, previous information given to them, and patients' severity of disease (SAPS). RESULTS The median score of the questionnaire was 11 (2-14), and the cut-off for satisfaction was established at 9 (1st quartile). SAPS >41 was associated with lower satisfaction [(p<0.05, chi-square, OR 2.49 (CI 1.1-5.4)]. When those interviewed surmised a prognosis different from the final outcome [p<0.05, chi-square, OR 2.70 (1.2-6.0)], a significant association with dissatisfaction was found. CONCLUSION More discussion about prognosis may improve the level of satisfaction of cancer patients' family members with the intensive care unit.
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Affiliation(s)
- Renata Rego Lins Fumis
- Unidade de Terapia Intensiva, Centro de Tratamento e Pesquisa Hospital do Câncer, Rua Prof. Antonio Prudente 211, CEP 01509-900 São Paulo, SP, Brazil
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Peters SG. Intensive care or end-of-life care for critically ill cancer patients?*. Crit Care Med 2005; 33:678-9. [PMID: 15753768 DOI: 10.1097/01.ccm.0000155774.91242.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Williams MD, Braun LA, Cooper LM, Johnston J, Weiss RV, Qualy RL, Linde-Zwirble W. Hospitalized cancer patients with severe sepsis: analysis of incidence, mortality, and associated costs of care. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:R291-8. [PMID: 15469571 PMCID: PMC1065011 DOI: 10.1186/cc2893] [Citation(s) in RCA: 219] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2004] [Revised: 05/20/2004] [Accepted: 05/21/2004] [Indexed: 12/21/2022]
Abstract
Introduction Infection is an important complication in cancer patients, which frequently leads to or prolongs hospitalization, and can also lead to acute organ dysfunction (severe sepsis) and eventually death. While cancer patients are known to be at higher risk for infection and subsequent complications, there is no national estimate of the magnitude of this problem. Our objective was to identify cancer patients with severe sepsis and to project these numbers to national levels. Methods Data for all 1999 hospitalizations from six states (Florida, Massachusetts, New Jersey, New York, Virginia, and Washington) were merged with US Census data, Centers for Disease Control vital statistics and National Cancer Institute, Surveillance, Epidemiology, and End Results initiative cancer prevalence data. Malignant neoplasms were identified by International Classification of Disease (ninth revision, clinical modification) (ICD-9-CM) codes (140–208), and infection and acute organ failure were identified from ICD-9-CM codes following Angus and colleagues. Cases were identified as a function of age and were projected to national levels. Results There were 606,176 cancer hospitalizations identified, with severe sepsis present in 29,795 (4.9%). Projecting national estimates for the US population, cancer patients account for 126,209 severe sepsis cases annually, or 16.4 cases per 1000 people with cancer per year. The inhospital mortality for cancer patients with severe sepsis was 37.8%. Compared with the overall population, cancer patients are much more likely to be hospitalized (relative risk, 2.77; 95% confidence interval, 2.77–2.78) and to be hospitalized with severe sepsis (relative risk, 3.96; 95% confidence interval, 3.94–3.99). Overall, severe sepsis is associated with 8.5% (46,729) of all cancer deaths at a cost of $3.4 billion per year. Conclusion Severe sepsis is a common, deadly, and costly complication in cancer patients.
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Affiliation(s)
- Mark D Williams
- Lilly Research Laboratories, Eli Lilly & Company, Indianapolis, Indiana, USA.
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Halpern NA, Pastores SM, Greenstein RJ. Critical care medicine in the United States 1985-2000: an analysis of bed numbers, use, and costs. Crit Care Med 2004; 32:1254-9. [PMID: 15187502 DOI: 10.1097/01.ccm.0000128577.31689.4c] [Citation(s) in RCA: 309] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To establish a database that permits description and analysis of the evolving role, patterns of use, and costs of critical care medicine (CCM) in the United States from 1985 to 2000. DESIGN Retrospective study combining data from federal (Hospital Cost Report Information System, Center for Medicare and Medicaid Services, Baltimore, MD) and private (Hospital Statistics, American Hospital Association, Chicago, IL) databases to analyze U.S. hospitals, hospital and CCM beds, and occupancy. CCM costs were calculated by the Russell equation and compared with national health care and financial indexes. SETTING Nonfederal, acute care hospitals with CCM units in the United States. SUBJECTS None. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We analyzed hospitals with CCM units and focused on hospital and CCM beds, CCM occupancy, and CCM costs. CCM costs were compared with national cost indexes. Between 1985 and 2000, the total number of U.S. hospitals decreased by 8.9% (6,032 to 5,494) and acute care hospitals offering CCM decreased by 13.7% (4,150 to 3,581). The total number of beds in hospitals with CCM units decreased by 26.4% (889,600 to 654,400). In contrast, CCM beds increased by 26.2% (69,300 to 87,400). CCM occupancy was constant at 65%. CCM bed costs per day increased by 126% (1,185 to 2,674 US dollars). Although CCM costs increased by 190.4% (19.1 billion to 55.5 billion US dollars), the proportion of national health expenditures allocated to CCM decreased by 5.4%. In 2000, CCM costs represented 13.3% of hospital costs, 4.2% of national health expenditures, and 0.56% of the gross domestic product. CONCLUSIONS CCM is increasingly used and prominent in a shrinking U.S. hospital system. CCM occupancy is lower than expected. Despite its increasing use and cost, CCM is using proportionally less of national health expenses and the gross domestic product than previously estimated.
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Affiliation(s)
- Neil A Halpern
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA.
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Abstract
As the number of elderly patients receiving oncologic therapies increases, the need for better outcome predictors for the critically ill elderly with cancer increases. Physicians should not view age as an indicator of poor ICU outcome, as many elderly patients with cancer will derive the same benefit from intensive care as their younger counterparts. Such a gain can be accomplished without overuse of valuable resources. Similar prognostic factors that are applied to the younger cancer patients should also be applied to the elderly. These parameters, in addition to clinical judgment, can be helpful in deciding who will benefit from ICU care regardless of age. Oncologists and critical care physicians will need to collaborate and change the paradigm of ICU care for the elderly.
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Affiliation(s)
- Kasra Karamlou
- Division of Hematology & Medical Oncology, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Road, L586, Portland, OR 97201, USA
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Abstract
Surgical evaluation of and therapy for the critically ill cancer patient continue to present significant challenges despite, or perhaps in part because of, an ongoing technologic refinement of therapeutic modalities within a modern ICU.
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Affiliation(s)
- S L Blair
- Department of General Oncologic Surgery, Division of Surgery, City of Hope National Medical Center, Duarte, California, USA
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Keenan CH, Kish SK. The Influence of Do-Not-Resuscitate Orders on Care Provided for Patients in the Surgical Intensive Care Unit of a Cancer Center. Crit Care Nurs Clin North Am 2000. [DOI: 10.1016/s0899-5885(18)30103-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Schein RM, Quartin AA. Severe chronic disease with acute physiologic disturbance: a role for intensive care. Crit Care Med 2000; 28:3099-100. [PMID: 10966312 DOI: 10.1097/00003246-200008000-00080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- G R Shapiro
- Medical Oncology Division, Milwaukee, University of Wisconsin Medical School 53201, USA
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Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB. Outcomes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med 1999; 160:1957-61. [PMID: 10588613 DOI: 10.1164/ajrccm.160.6.9812055] [Citation(s) in RCA: 196] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Critically ill cancer patients constitute a large percentage of admissions to tertiary care medical intensive care units (ICUs). We sought to describe outcomes of such patients, and to evaluate how conditions commonly seen in these patients impact mortality. A total of 348 consecutive medical ICU cancer patients were evaluated. Subgroup comparisons included the three most common cancer types (leukemia, lymphoma, lung cancer), as well as three different treatments/conditions (bone marrow transplant [BMT] versus non-BMT, mechanical ventilation [MV] versus non-MV, neutropenic versus non-neutropenic). There were no mortality differences between patients with leukemia, lymphoma, or lung cancer. By logistic regression, mortality predictors were: MV, hepatic failure, and cardiovascular failure for the group as a whole (41% overall mortality); MV and allogeneic (as compared with autologous) BMT for the BMT group (39% overall mortality); hepatic failure, cardiovascular failure, and persistent acute respiratory distress syndrome (ARDS) for the MV group (67% overall mortality); and MV for the neutropenic group (53% overall mortality). Neutropenia showed no independent association with mortality in the group as a whole or any subgroup analyzed. We conclude that respiratory, hepatic, and cardiovascular failure predict mortality, whereas neutropenia does not. Additionally, we have noted an encouraging improvement in survival in many groups of critically ill cancer patients.
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Affiliation(s)
- J P Kress
- Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA
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Cooper GS, Yuan Z, Stange KC, Amini SB, Dennis LK, Rimm AA. The utility of Medicare claims data for measuring cancer stage. Med Care 1999; 37:706-11. [PMID: 10424641 DOI: 10.1097/00005650-199907000-00010] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The validity of using claims data for measuring tumor stage, one of the most important determinants of choice of therapy and long-term survival, is unknown. OBJECTIVES To determine the relative accuracy of both inpatient and hospital Outpatient Medicare claims for measuring the stage of disease of six commonly diagnosed cancers. RESEARCH DESIGN Analysis of a database linking Surveillance, Epidemiology, and End Results (SEER) registry data and Medicare claims in patients aged 65 years with cancer. SUBJECTS Three hundred twenty thousand, six hundred and thirty seven cases of invasive breast, colorectal, endometrial, lung, pancreatic, and prostate cancers diagnosed between 1984 and 1993. MEASURES Using SEER files as the "gold standard," concordance with Medicare claims, as well as sensitivity and positive predictive value of coding for each stage was measured. RESULTS Although Medicare data correctly categorized local, regional, and distant stage tumors in 97%, 33%, and 65%, respectively, the data substantially overestimated the proportion of localized tumors and underestimated the rate of regional stage disease. The highest concordance was observed for breast and colorectal cancer. However, the sensitivity and positive predictive values were never simultaneously 80% within one stage of a specific cancer. The accuracy of coding for stage in Outpatient files was inferior to inpatient data. CONCLUSIONS With few exceptions, Medicare claims have limited utility as a measure of cancer stage. If tumor registry data are not available, investigators should consider the trade offs in sensitivity and predictive value when considering a study that will use claims data.
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Affiliation(s)
- G S Cooper
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
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Amir M, Shabot MM, Karlan BY. Surgical intensive care unit care after ovarian cancer surgery: an analysis of indications. Am J Obstet Gynecol 1997; 176:1389-93. [PMID: 9215205 DOI: 10.1016/s0002-9378(97)70366-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Our purpose was to develop a profile of preoperative and perioperative characteristics that would enable gynecologic oncologists to identify those patients with ovarian cancer who would benefit most from postoperative surgical intensive care unit care and thereby optimize resource utilization and cost effectiveness. STUDY DESIGN A retrospective analysis was performed of 85 patients admitted to the surgical intensive care unit after cytoreductive surgery between Jan. 1, 1989, and Dec. 31, 1993. Fifty-three patients admitted to the surgical intensive care unit for < 24 hours were compared with 32 patients admitted for > 24 hours. Five preoperative characteristics (age, American Society of Anaesthesiology classification, body mass index, albumin, primary versus recurrent disease) and six perioperative characteristics (estimated blood loss, ascites, surgical time, bowel resection, Swan-Ganz catheter, ventilator dependence) were compared across the two groups by univariate analysis and multivariate logistic regression analyses. RESULTS All preoperative variables were similar across the two groups. Ascites volume and length of surgery were not significant, whereas estimated blood loss was significant in the univariate analysis but not in the logistic regression analysis. Three perioperative variables were found to be predictive of extended surgical intensive care unit care by logistic regression analysis: placement of a Swan-Ganz catheter (odds ratio 4.31, 95% confidence interval 1.13 to 16.4), bowel resection (odds ratio 13.0, 95% confidence interval 1.96 to 86.5), and ventilator dependence (excluded from logistic regression analysis for mathematic reasons). CONCLUSIONS The patient's preoperative medical condition proved to be less important than how she fares during surgery. The patient most likely to benefit from surgical intensive care unit care had undergone bowel resection, required invasive hemodynamic monitoring, or was ventilator dependent postoperatively. This patient profile may prove to be a useful screening tool to optimize resource utilization and cost effectiveness, but it cannot replace clinical judgment.
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Affiliation(s)
- M Amir
- Department of Obstetrics and Gynecology, University of California, Los Angeles Cedars-Sinai Medical Center 90048, USA
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