The Effect of Critical Care Transition Programs on the Short-Term Outcomes of Critically Ill Cancer Patients: A Propensity Score Matching Study

Objective: The objective of the study is to investigate the effect of critical care transition programs (TPs) on the short-term outcomes in critically ill cancer patients. Methods: Data of critically ill cancer patients admitted to the intensive care unit (ICU) at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between September 2017 and August 2018 were retrospectively reviewed and analyzed. Patients were grouped as TP group or non-TP (nTP) group according to whether patients received post-ICU follow-up. Results: In unmatched groups, compared with nTP group, patients in TP group were more severe with higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher Simplified Acute Physiology Score 3 score, and higher Sequential Organ Failure Assessment score and decreased ICU mortality (0 vs. 3.1%, P = 0.001) and in-hospital mortality (0 vs. 3.2%, P = 0.001). After matching, there were no significant differences in readmission rate, in-hospital mortality, readmission/in-hospital mortality, ICU length of stay (LOS), and hospital LOS between TP and nTP groups (all P > 0.05). Subgroup analysis demonstrated that in severe group (APACHE II >15), compared with nTP group, patients in TP group had increased readmission rate (8.3% vs. 62.5%, P < 0.001) and increased duration of hospital LOS (13.92 ± 10.54 vs. 26.38 ± 15.46 days; P = 0.003). There is a trend that ICU mortality (23.6% vs. 0, P = 0.121) and hospital mortality (25.8% vs. 0, P = 0.108) were decreased in TP group than in nTP group. In less severe group (APACHE II ≤ 15), there were no significant differences in readmission rate (4.5% vs. 3.8%, P = 0.655), ICU LOS (3.00 ± 4.40 vs. 2.92 ± 3.23 days; P = 0.790), ICU mortality (1.0% vs. 0, P = 0.117), and hospital mortality (1.0% vs. 0, P = 0.117). Conclusions: Critical care TPs may decrease ICU mortality and hospital mortality in critically ill cancer patients with APACHE II >15. It has no role in less severe critically ill cancer patients with APACHE II ≤15.