老年人在术后需要高危ICU住院，但是很少有人知道这些住院对生活质量的影响。本研究的目的是评估非预期术后ICU住院对年龄较大、经历了高强度癌症手术并在出院后生存的患者的癌症症状负担的影响。我们对2007年至2017年在加拿大安大略省接受高强度癌症手术且在出院后生存的老年人（年龄≥70岁）进行了一项基于人群的队列研究。保留患者报告的身体、心理和情感症状的标准化工具——埃德蒙顿症状评估系统（ESAS），描述了手术后一年内的癌症症状负担。总体症状得分≥40表示中度至重度症状负担。使用修正的对数泊松分析来评估非预期术后ICU住院（与例行监测无关的住院）对术后一年内经历中度至重度症状负担的患者的影响，考虑到潜在混杂因素。然后，我们使用多变量广义线性混合模型对具有两个或更多ESAS评估的患者的症状轨迹进行建模。总症状得分的10分差异被认为具有临床意义。在16,560名患者（平均年龄76.5岁；43.4%女性）中，有1,503名（9.1%）非预期ICU住院。在考虑基线特征后，与没有非预期ICU住院的患者相比，有非预期ICU住院的患者更有可能经历中度至重度症状负担（RR 1.64，95% CI 1.31-2.05）。具体而言，在有预期ICU住院的患者中，经历中度至重度症状的平均概率从手术后第一个月的6.9%（95 CI 5.8-8.3%）到年末的3.2%（95% CI 0.9-11.7%）不等。在11,229名（67.8%）进行了多次ESAS评估的患者中，在整个一年中，具有和没有非预期ICU住院的患者之间的调整总分差异从2.0到5.7分不等（P<0.001）。虽然非预期ICU住院与经历中度至重度症状负担的可能性略微增加有关，但大多数患者在手术后一年内没有高的总体症状负担。这些发现支持在老年人进行重大手术后采取积极治疗的作用。 © 2023. The Author(s)。

Older adults are at high-risk for a post-operative intensive care unit (ICU) admission, yet little is known about the impact of these admissions on quality of life. The objective of this study was to evaluate the impact of an unexpected post-operative ICU admission on the burden of cancer symptoms among older adults who underwent high-intensity cancer surgery and survived to hospital discharge.We performed a population-based cohort study of older adults (age ≥ 70) who underwent high-intensity cancer surgery and survived to hospital discharge in Ontario, Canada (2007-2017). Using the Edmonton Symptom Assessment System (ESAS), a standardized tool that quantifies patient-reported physical, mental, and emotional symptoms, we described the burden of cancer symptoms during the year after surgery. Total symptom scores ≥ 40 indicated a moderate-to-severe symptom burden. Modified log-Poisson analysis was used to estimate the impact of an unexpected post-operative ICU admission (admission not related to routine monitoring) on the likelihood of experiencing a moderate-to-severe symptom burden during the year after surgery, accounting for potential confounders. We then used multivariable generalized linear mixed models to model symptom trajectories among patients with two or more ESAS assessments. A 10-point difference in total symptom scores was considered clinically significant.Among 16,560 patients (mean age 76.5 years; 43.4% female), 1,503 (9.1%) had an unexpected ICU admission. After accounting for baseline characteristics, patients with an unexcepted ICU admission were more likely to experience a moderate-to-severe symptom burden relative to those without an unexpected ICU admission (RR 1.64, 95% CI 1.31-2.05). Specifically, among patients with an unexcepted ICU admission the average probability of experiencing moderate-to-severe symptoms ranged from 6.9% (95 CI 5.8-8.3%) during the first month after surgery to 3.2% (95% CI 0.9-11.7%) at the end of the year. Among the 11,229 (67.8%) patients with multiple ESAS assessments, adjusted differences in total scores between patients with and without an unexpected ICU admission ranged from 2.0 to 5.7-points throughout the year (p < 0.001).While unexpected ICU admissions are associated with a small increase in the likelihood of experiencing a moderate-to-severe symptom burden, most patients do not experience a high overall symptom burden during the year after surgery. These findings support the role of aggressive therapy among older adults after major surgery.© 2023. The Author(s).