Analysis of Risk Factors for prolonged Intensive Care Unit Stay After Colorectal Cancer Surgery

Xuefeng Song¹Yabin Liu^2,3,4,5Biao Dong^4*

• ¹Department of Hematology, Shanxi Provincial Cancer Hospital, Taiyuan, China
• ²Hebei Medical University, Shijiazhuang, China
• ³Hebei Medical University, Shijiahzuang, China
• ⁴Fourth Hospital of Hebei Medical University, shijiazhuang, China
• ⁵Hebei Medical U, shijiazhuang, China

Objective: This study employed a retrospective analysis to investigate the risk factors associated with prolonged ICU stay following colorectal cancer surgery. Methods: A total of 325 patients who underwent colorectal cancer surgery and were subsequently transferred to the ICU were enrolled as the colorectal cancer group. ICU length of stay was stratified by quartiles, with the 75th percentile (≥61 hours) defined as the prolonged ICU stay group. Results: Among the 325 enrolled patients (median age 77 years), 183 (56.3 %) were male and 142 (43.7 %) were female. The cohort was divided into a normal group (n = 243) and a prolonged group (n = 82). Univariate analysis identified preoperative obstruction, preoperative perforation, Class IV surgical incisions, open surgical approach, intraoperative blood loss, duration of mechanical ventilation, perioperative sepsis, perioperative AKI, lower extremity deep vein thrombosis , and mean postoperative platelet count, albumin, and blood urea nitrogen levels within the first 24 hours of ICU admission as risk factors for prolonged ICU stay. After adjusting for confounding factors, multivariate logistic regression analysis revealed that the laparotomy, perioperative sepsis, postoperative duration of mechanical ventilation, occurrence of lower extremity DVT, and mean platelet count within the first day of ICU admission were independent risk factors for prolonged ICU stay. ROC curve was 0.8081 (95% CI: 0.745–0.870), indicating strong discriminatory ability. Calibration curve demonstrated excellent agreement between predicted and observed outcomes ( [O:E] ratio = 1.000, [CITL] = -0.000, slope = 1.000). Bootstrap validation yielded a Brier score of 24.1%, a concordance statistic (C-statistic) of 0.772, an E:O ratio of 0.981, a slope of 0.756, and a CITL of 0.029. DCA revealed a high net benefit for predicting prolonged ICU stay at lower threshold probabilities. Subgroup analysis by surgical site (left-sided vs. right-sided colon cancer) showed AUCs of 0.7892 (95% CI: 0.71–0.87) for left-sided colon cancer and for right-sided colon cancer of 0.8253 (95% CI: 0.72–0.93) . Conclusion: The laparotomy, perioperative sepsis, postoperative duration of mechanical ventilation, occurrence of DVT, and mean platelet count within the first day of ICU admission were independent risk factors for prolonged ICU stay following colorectal cancer surgery.