Postoperative ICU outcomes and predictors of morbidity and mortality in cancer patients after oncosurgery: A retrospective study from a tertiary care center in India.

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Background: Surgery remains the cornerstone of curative treatment for many malignancies, yet, postoperative complications remain disproportionately higher in LMIC setting. Rescuing patients who sustain a major complication post oncosurgery, from dying has become an important focus in quality improvement post onco-surgery. Therefore, this study was designed to assess factors and variables linked with morbidity and mortality in patients admitted to critical care facility after oncosurgery so that measures to curb and minimize them can be undertaken. Methods: Study design: Retrospective Observational Study. Setting: Single centre. Duration: Data collection from 1st January 2018-31st December 2023. Primary objective: To assess the mortality rates and identify predictors of mortality in cancer patients admitted to ICU post onco-surgery. Secondary objective: To assess postoperative complications and identify predictors of morbidity. Inclusion criteria: 1. 18 years or older. 2. Patients diagnosed with solid organ malignancy undergoing onco-surgery for the same. Exclusion criteria: 1. Age <18 years. 2. Non surgical patients with solid organ malignancy admitted to ICU. 3. Patients with haematological malignancies admitted to ICU. Data collection: Medical records of ICU admissions between January 1st 2018-December 31st 2023 were retrospectively screened to identify patients fulfilling the inclusion criteria. 69 variables pertaining to the perioperative period were collected. Postoperative 30-day mortality was recorded. Postoperative morbidity was graded using Clavien Dindo classification. Statistical analysis: A logistic (univariate and multivariate) regression analysis was performed to identify independent predictors of morbidity and mortality. A p value <0.05 was considered statistically significant. Missing data were handled using complete case analysis. No imputation was performed. Ethical clearance: From Institute Ethics Committee of All India Institute of Medical Sciences, New Delhi. The trial was registered at CTRI (Clinical Trials Registry of India) portal. Results: Major postoperative morbidity (Clavien Dindo>/III) occurred in 28.6% of patients, while 30-day mortality was 8.9%. Independent predictors of mortality included surgical site infection (SSI) (OR 2.84, 95% CI 1.98-4.07; P<0.001), preoperative deranged RFTs (OR 2.32; 95% CI1.66-3.22; p<0.05), ASA II-IV (OR 1.94; 95% CI 1.39-2.71; p<0.001), re-do surgeries/reexplorations (OR 2.47; 95% CI 1.61-3.79; p<0.05) and type 2 diabetes mellitus (OR 1.76; 95% CI 1.21-2.56; P<0.05). Conclusions: Postoperative cancer patients requiring ICU admission represent a high risk cohort. Optimization of modifiable risk factors and strengthened perioperative surveillance may improve outcomes in this vulnerable population.