Life Support in the ICU: Outcomes Among Patients Undergoing Gastrointestinal Cancer Surgery.

Abstract

Postoperative intensive care use after gastrointestinal cancer surgery may reflect evolving perioperative triage, yet national patterns of intensive care unit admission and life-support intervention use remain poorly defined. Adults undergoing gastrointestinal cancer surgery in Epic Cosmos between 2016 and 2025 were identified. Intensive care unit admission and postoperative life-support intervention use, defined as invasive mechanical ventilation for ≥24 consecutive hours and/or continuous vasopressor infusion during the index hospitalization, were assessed over time. Multivariable logistic regression evaluated predictors of life-support use and associations with short-term outcomes, adjusting for sociodemographic and clinical factors. Among 376,503 patients, 21.8% (n=82,076) underwent postoperative intensive care unit admission; 88.6% (n=72,702) of these received life-support interventions. From 2016 to 2025, intensive care unit admissions declined by 8.4% (95% CI 6.7-10.1), whereas life-support intervention use increased by 24.2% (95% CI 22.8-25.6) (both p<0.001). Life-support intervention use was more frequent among males (59.3% vs 56.9%), patients with comorbidity (53.7% vs 44.8%), and emergency presentations (24.7% vs 17.8%) (all p<0.001). Compared with colorectal cancer, esophageal cancer surgery had the highest odds of life-support intervention use (aOR 2.42, 95% CI 2.16-2.72). Life-support intervention use was associated with prolonged hospitalization (aOR 2.89, 95% CI 2.66-3.14), complications (aOR 1.94, 95% CI 1.85-2.04), 30-day mortality (aOR 2.82, 95% CI 2.50-3.19), and lower odds of discharge home (aOR 0.25, 95% CI 0.23-0.27) (all p<0.001). After gastrointestinal cancer surgery, intensive care unit use declined while life-support intervention use increased, indicating more selective concentration of higher-acuity postoperative care. Life-support intervention use was strongly associated with adverse short-term outcomes and may serve as a marker of postoperative severity to inform perioperative risk stratification and critical-care resource planning.