AGE AND UTILIZATION OF INTENSIVE-CARE UNIT RESOURCES OF CRITICALLY ILL CANCER-PATIENTS

Older patients, patients with malignancies, and those admitted to ICUs utilize a disproportionate amount of hospital resources. To evaluate the combined impact of age and a diagnosis of malignancy on ICU utilization and outcome, we reviewed the care provided to all 1,212 patients admitted to a medical/surgical ICU in a hospital specializing in the treatment of cancer between January 1, 1986 and December 31, 1987. Patients between 19 and 64 yr (young) were compared with those between 65 and 74 yr (young-old) and with those ≥75 yr (old-old) with respect to utilization of nutritional support (total parenteral nutrition [TPN]), mechanical ventilation (MV), pulmonary artery (PA) catheterization, dialysis (D), and blood products (B). Mean length of stay (LOS) in the ICU, primary diagnosis, outcome, and average daily severity of illness scores (ADTIS) were also compared. Old-old patients represented 14% of all ICU patients and young-old patients represented 28%; 64% of old-old and 61% of young-old patients had solid tumors, compared with 36% of the younger patients. The ICU mortality of the two older groups was significantly lower than that of the younger patients (17%, 27%, and 30%, respectively). The use of TPN, PA catheters, and D was similar for all three groups, but older patients used less MV and B than the younger patients (p < .0001, χ2 analysis). The two older groups also had similar LOS and lower average daily Therapeutic Intervention Scoring System (TISS) scores than their younger cohort. When patients were compared according to primary diagnosis, patients with solid tumors were generally older (64.6 ± 0.5 vs. 53.1 ± 0.7 yr, mean 58.5 ± 0.5) and had longer ICU LOS (6.8 ± 0.4 vs. 6.0 ± 0.3 days) and lower mean TISS scores (31.5 ± 0.8 vs. 35.7 ± 0.8) than patients with soft tissue malignancies. Patients with solid tumors also had lower ICU, floor, and total mortality rates than those who had systemic malignancies. Diagnosis did not significantly influence resource utilization, although of the patients who received TPN, solid tumor patients received it for a greater number of days. When patients with the same diagnosis were further subdivided by age groups, no significant differences were noted in LOS, ADTIS, and overall outcome among patients with solid tumors. Older patients with systemic malignancies, however, had shorter ICU LOS and lower TISS scores than younger patients. Similarly, older patients had better outcomes in terms of ICU and total (ICU plus floor) mortality. The results of this investigation strongly suggest that age should not be a determining factor in the allocation of ICU beds to patients with malignancies.