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Publication Abstract

Authors: Cooke CR, Feemster LC, Wiener RS, O'Neil ME, Slatore CG

Title: Aggressiveness of intensive care use among patients with lung cancer in the SEER-Medicare registry.

Journal: Chest :-

Date: 2014 Jun 19

Abstract: ABSTRACT: Background:Approximately 65% of elderly patients with lung cancer who are admitted to the intensive care unit (ICU) will die within six months. Efforts to improve end of life care for this population must first understand the patient factors that underlie admission to the ICU Methods:We performed a retrospective cohort study examining all fee-for-service inpatient claims in the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry for elderly patients (age > 65) diagnosed with lung cancer between 1992 and 2005 who were hospitalized for reasons other than resection of their lung cancer. We calculated yearly rates of ICU admission per 1000 hospitalizations via room and board codes or ICD-9-CM and DRG codes for mechanical ventilation, stratified rates by receipt of mechanical ventilation and ICU type (medical/surgical/cardiac vs. intermediate), and compared these rates over time. Results:A total of 175,756 patients with lung cancer in SEER were hospitalized for a reason other than surgical resection of their tumor during the study period, 49,373 (28%) of whom had at least one ICU stay. The rate of ICU admission per 1000 hospitalizations increased over the study period from 140.7 in 1992 to 201.7 in 2005 (p<0.001). The majority of the increase in ICU admissions (per 1000 hospitalizations) between 1992 and 2005 occurred among patients who were not mechanically ventilated (118.2 to 173.3, p<0.001), in intermediate ICUs (20.0 to 61.9, p<0.001), but increased only moderately in medical/surgical/cardiac units (120.7 to 139.9 p<0.001). Conclusions:ICU admission for patients with lung cancer increased over time, mostly among patients without mechanical ventilation who were largely cared for in intermediate ICUs. Background: Approximately 65% of elderly patients with lung cancer who are admitted to the intensive care unit (ICU) will die within six months. Efforts to improve end of life care for this population must first understand the patient factors that underlie admission to the ICU. Methods: We performed a retrospective cohort study examining all fee-for-service inpatient claims in the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry for elderly patients (age > 65) diagnosed with lung cancer between 1992 and 2005 who were hospitalized for reasons other than resection of their lung cancer. We calculated yearly rates of ICU admission per 1000 hospitalizations via room and board codes or ICD-9-CM and DRG codes for mechanical ventilation, stratified rates by receipt of mechanical ventilation and ICU type (medical/surgical/cardiac vs. intermediate), and compared these rates over time. Results: A total of 175,756 patients with lung cancer in SEER were hospitalized for a reason other than surgical resection of their tumor during the study period, 49,373 (28%) of whom had at least one ICU stay. The rate of ICU admission per 1000 hospitalizations increased over the study period from 140.7 in 1992 to 201.7 in 2005 (p<0.001). The majority of the increase in ICU admissions (per 1000 hospitalizations) between 1992 and 2005 occurred among patients who were not mechanically ventilated (118.2 to 173.3, p<0.001), in intermediate ICUs (20.0 to 61.9, p<0.001), but increased only moderately in medical/surgical/cardiac units (120.7 to 139.9 p<0.001). Conclusions: ICU admission for patients with lung cancer increased over time, mostly among patients without mechanical ventilation who were largely cared for in intermediate ICUs.

Last Modified: 03 Sep 2013