597: Unplanned Admissions to an Oncologic ICU after Planned Procedures

Abstract

Introduction: Unplanned admissions to the ICU have been reported in the elderly, in emergency department admissions, and after orthopedic and day surgical procedures. There is limited data on unplanned ICU admissions following routine planned outpatient procedures on patients scheduled for hospital discharge within 24 hours. Methods: Using hospital and ICU databases, we retrospectively analyzed 4,625 admissions to a 20-bed oncologic ICU between January 1, 2008 and December 31, 2012. Data collected included type of procedure, hospital location for procedure, and complications of planned procedure; demographics (age, gender); cancer diagnosis, Mortality Probability Model (MPM) II score and lactate level on ICU admission; use of vasopressors and/or mechanical ventilation, and ICU length of stay (LOS) and mortality. Results: During the 5-year study period, there were 21 (0.5%) unplanned ICU admissions following planned outpatient procedures in Interventional Radiology (43%), Surgical Day Hospital Operating Room (OR) (43%) and GI suites (14%). Majority of patients were female (67%) with a mean age of 64 years, MPM II score of 26% and a lactate level of 1.2. The most common procedures associated with ICU admissions were hepatic (liver biopsy, n=3, radio-frequency ablation, n=2), GI (upper endoscopy, n=2, PEG tube, n=1), breast procedures (biopsy, n=3, mastectomy, n=1), prostate, and vascular. A variety of neurological, respiratory, cardiac, renal, hematologic, and anaphylaxes complications resulted in ICU admission. Approximately 20% of these patients required mechanical ventilation and/or vasopressors. Mean hospital LOS was 1.5 days. None of the patients expired. 71% of the patients were discharged home, 10% to inpatient wards, and 19% to outside facilities. Conclusions: Unplanned admissions to an oncologic ICU after routine planned outpatient procedures are a rare source of ICU admissions. Complications involving multiple organ systems occurred. The vast majority of patients had a short ICU and hospital LOS and all survived. Further study is required to determine if such patients can be identified pre-procedure or if these types of complications are simply the statistical risk of performing an ever increasing number of outpatient procedures on sick patients.