Acute Crit Care.  2024 Nov;39(4):554-564. 10.4266/acc.2024.00808.

Effects of closed- versus open-system intensive care units on mortality rates in patients with cancer requiring emergent surgical intervention for acute abdominal complications: a single-center retrospective study in Korea

• Lee JH
• Kim JH
• You KH
• Han WH

• KMID: 2563544
• DOI: http://doi.org/10.4266/acc.2024.00808

Abstract

Background
In this study, we aimed to compare the in-hospital mortality of patients with cancer who experienced acute abdominal complications that required emergent surgery in open (treatment decisions made by the primary attending physician of the patient's admission department) versus closed (treatment decisions made by intensive care unit [ICU] intensivists) ICUs.
Methods
This retrospective, single-center study enrolled patients with cancer admitted to the ICU before or after emergency surgery between November 2020 and September 2023. Univariate and logistic regression analyses were conducted to explore the associations between patient characteristics in the open and closed ICUs and in-hospital mortality.
Results
Among the 100 patients (open ICU, 49; closed ICU, 51), 23 died during hospitalization. The closed ICU group had higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vasopressor use, mechanical ventilation, and preoperative lactate levels and a shorter duration from diagnosis to ICU admission, surgery, and antibiotic administration than the open ICU group. Univariate analysis linked in-hospital mortality and APACHE II score, postoperative lactate levels, continuous renal replacement therapy (CRRT), and mechanical ventilation. Multivariate analysis revealed that in-hospital mortality rate increased with CRRT use and was lower in the closed ICU.
Conclusions
Compared to an open ICU, a closed ICU was an independent factor in reducing in-hospital mortality through prompt and appropriate treatment.

Keyword

acute care surgery; continuous renal replacement therapy; intensive care unit; mortality; patients with cancer

Figure

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  Figure 1. Flowchart of the participant selection process. ICU: intensive care unit.

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  Figure 2. Forest plot of the odds ratios (ORs) for in-hospital mortality of patients with cancer requiring emergent surgery for acute abdominal complications. Treatment in the closed intensive care unit (ICU) was associated with decreased in-hospital mortality compared with the open-type ICU (P=0.025), and continuous renal replacement therapy (CRRT) was associated with increased mortality (P=0.032). Acute Physiology and Chronic Health Evaluation (APACHE) II score, postoperative lactate level, and time from diagnosis to operation were not significantly associated with in-hospital mortality.

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  Figure 3. Kaplan-Meier survival analysis based on the type of intensive care unit (ICU) for patients with cancer requiring emergent surgical intervention for acute abdominal complications. Cumulative survival rate was significantly higher in the closed ICU group than in the open ICU group (P=0.033). The log-rank test was applied to compare survival curves.

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