Charting Postoperative Trajectories in Patients With Cancer: Perspectives From a Resource-Constrained Setting in Northeast India.

Abstract

Purpose: Perioperative monitoring in critical care facility is a major determinant of postoperative outcome. However, critical care resources are finite and expensive. Thus, identifying those most likely to benefit is of great importance in resource-constrained settings. Hence, this study aims to identify prognostic factors predicting postoperative mortality and morbidity for patients in surgical units. This may help in identifying high-risk patients and developing an approach to reduce mortality.

Methods: This was a cohort study involving secondary data of all patients with cancer age 18 years and older and admitted to the critical care. Preoperative, intraoperative, and postoperative parameters were extracted in Excel from the cloud physician electronic database. Descriptive analysis and log-binomial regression were used to analyze the data using STATA version 12. 1. Poor postoperative outcomes were defined as the occurrence of morbidity (unplanned postoperative course) or mortality.

Results: The study included 421 patients with a mean age of 58.02 years (SD, 12.85). The majority of the patients were in the age range of 41-60 years (53%), 29% were older than 60 years, and 88% were found to use tobacco. Of all patients, 287 (68%) had significant postoperative morbidity and 13 patients (3%) died. Acute Physiology and Chronic Health Evaluation (APACHE-II) score >15 (adjusted relative risk [RR], 4.5 [95% CI, 1.48 to 14.01]), surgeon's experience <10 years (adjusted RR, 1.7 [95% CI, 1.06 to 2.94]), and blood loss more than 100 ml (adjusted RR, 2.42 [95% CI, 1.43 to 4.10]) were found to be significant predictors of poor postoperative outcomes.

Conclusion: Higher APACHE-II scores, significant blood loss, and operated by less experienced surgeon were the major determinants of poor postoperative outcomes and necessitate postoperative monitoring in critical care facilities.