Cardiac complications as a major driver of ICU utilization in hospitalized cancer patients: A National Inpatient Sample analysis, 2018–2022.

Abstract

e23167 Background: ICU-level escalation in hospitalized cancer patients is commonly attributed to sepsis or respiratory failure. The relative contribution of acute cardiac complications to critical care utilization remains less well defined. This study evaluated whether cardiac complications independently drive ICU utilization compared with sepsis and respiratory failure during cancer hospitalizations. Methods: A retrospective serial cross-sectional analysis was conducted using adult hospitalizations with a principal diagnosis of malignancy in the 2018–2022 National Inpatient Sample with discharge-level survey weighting. Three competing inpatient drivers were identified using any-diagnosis codes: (1) cardiac complications, including arrhythmia, heart failure, acute myocardial infarction, myocarditis, pericarditis, demand ischemia, stress cardiomyopathy, or cardiac arrest; (2) sepsis; and (3) respiratory failure or acute respiratory distress syndrome. ICU utilization was assessed using a proxy defined as shock or mechanical ventilation. Outcomes included ICU proxy utilization, mechanical ventilation, shock, length of stay, and hospitalization cost. Survey-weighted multivariable models adjusted for demographics, payer, ZIP-code income quartile, admission type, cancer subtype, hospital characteristics, and year, with all three drivers entered simultaneously. Results: Among 961,848 unweighted cancer hospitalizations, representing 4.81 million admissions nationally, cardiac complications occurred in 20.1%, respiratory failure in 10.7%, and sepsis in 3.2%. ICU proxy utilization occurred in 3.49% overall. ICU utilization was lowest in hospitalizations with none of the three drivers (0.84%) and higher in cardiac-only (2.43%), sepsis-only (7.09%), respiratory failure-only (15.03%), and mixed-driver admissions (27.85%). Length of stay and cost increased in parallel, ranging from 5.65 days and $20,230 with no drivers to 14.70 days and $50,397 with mixed drivers. In adjusted models, cardiac complications independently increased odds of ICU utilization (adjusted odds ratio 2.08, 95% CI 2.02–2.14), although respiratory failure (adjusted odds ratio 15.84) and sepsis (adjusted odds ratio 6.22) were stronger per-case predictors. Cardiac complications also independently increased length of stay (+1.43 days) and cost (+$6,169). Conclusions: Cardiac complications are common during cancer hospitalizations and independently contribute to ICU utilization and increased resource use, even after accounting for sepsis and respiratory failure. Although respiratory failure and sepsis confer higher per-case ICU risk, the high prevalence of cardiac complications identifies them as a major driver of critical care burden in oncology hospitalizations.