The impact of the COVID-19 pandemic on the decrease in the use of intensive care units in the postoperative period of anatomic lung resections. A retrospective analysis

ABSTRACT Objective: COVID-19 pandemic required optimization of hospital institutional flow, especially regarding the use of intensive care unit (ICU) beds. The aim of this study was to assess whether the individualization of the indication for postoperative recovery from pulmonary surgery in ICU beds was associated with more perioperative complications. Method: retrospective analysis of medical records of patients undergoing anatomic lung resections for cancer in a tertiary hospital. The sample was divided into: Group-I, composed of surgeries performed between March/2019 and February/2020, pre-pandemic, and Group-II, composed of surgeries performed between March/2020 and February/2021, pandemic period in Brazil. We analyzed demographic data, surgical risks, surgeries performed, postoperative complications, length of stay in the ICU and hospital stay. Preventive measures of COVID-19 were adopted in group-II. Results: 43 patients were included, 20 in group-I and 23 in group-II. The groups did not show statistical differences regarding baseline demographic variables. In group-I, 80% of the patients underwent a postoperative period in the ICU, compared to 21% in group-II. There was a significant difference when comparing the average length of stay in an ICU bed (46 hours in group-I versus 14 hours in group-II - p<0.001). There was no statistical difference regarding postoperative complications (p=0.44). Conclusions: the individualization of the need for ICU use in the immediate postoperative period resulted in an improvement in the institutional care flow during the COVID-19 pandemic, in a safe way, without an increase in surgical morbidity and mortality, favoring the maintenance of essential cancer treatment.

摘要
研究目的：新冠大流行要求优化医院诊疗流程，尤其针对重症监护病房（Intensive Care Unit）床位的使用。本研究旨在评估肺手术后在ICU床位进行康复的指征个体化是否与更多围手术期并发症相关。
研究方法：对某三级医院内因癌症接受解剖性肺切除术的患者病历开展回顾性分析。研究队列分为两组：组1纳入2019年3月至2020年2月（新冠大流行前）接受手术的患者，组2纳入2020年3月至2021年2月（巴西新冠大流行期间）接受手术的患者。本研究分析了两组患者的人口统计学资料、手术风险、手术方式、术后并发症、ICU停留时长及住院总时长。组2患者均采取了新冠防控措施。
研究结果：本研究共纳入43例患者，组1与组2分别为20例和23例。两组的基线人口统计学变量无统计学差异。组1中80%的患者术后在ICU留观康复，而组2该比例仅为21%。两组的ICU平均停留时长存在显著统计学差异（组1为46小时，组2为14小时，p<0.001）。两组的术后并发症发生率无统计学差异（p=0.44）。
研究结论：术后即刻ICU使用需求的个体化，在新冠大流行期间安全优化了医院诊疗流程，未增加手术相关发病率与死亡率，有助于维持必要的癌症诊疗服务。