ASO Author Reflections: The Role of the ICU for Older Adults After High-Risk Cancer Surgery

Excerpt

The role of the intensive care unit (ICU) for older adults is controversial.¹ Compared with younger patients, adults older than 65 years are at increased risk of death, and those who survive their ICU admission face the possibility of cognitive decline, functional limitations, and decreased quality of life.² However, older adults are a heterogeneous population, and evidence suggests that a history of functional decline before ICU admission, not age or number of comorbidities, is the major predictor of outcomes after critical illness.³ Consequently, current evidence regarding ICU outcomes for older adults may not be applicable to those who have recently undergone cancer surgery. These patients represent a highly select population, and their ICU admissions are likely related to potentially reversible postoperative events, as opposed to ongoing functional decline. This lack of data limits clinicians’ ability to counsel patients and their care partners effectively, both preoperatively and during potential complications that may arise in the postoperative period. It also complicates discussions between critical care, surgical, and oncology teams regarding therapies and goals of care, especially as perceptions of outcomes differ among providers.⁴ To provide better support for decision-making regarding aggressive life-prolonging measures within this patient population, this study sought to examine the impact of an unexpected postoperative ICU admission after cancer surgery on the time older adults spent alive and at home.⁵ …