Life Support in the ICU: Outcomes Among Patients Undergoing Gastrointestinal Cancer Surgery

BACKGROUND: Postoperative intensive care use after gastrointestinal cancer surgery may reflect evolving perioperative triage, yet national patterns of intensive care unit admission and life-support intervention use remain poorly defined. STUDY DESIGN: Adults undergoing gastrointestinal cancer surgery in Epic Cosmos between 2016 and 2025 were identified. Intensive care unit admission and postoperative life-support intervention use, defined as invasive mechanical ventilation for ≥24 consecutive hours and/or continuous vasopressor infusion during the index hospitalization, were assessed over time. Multivariable logistic regression evaluated predictors of life-support use and associations with short-term outcomes, adjusting for sociodemographic and clinical factors. RESULTS: Among 376,503 patients, 21.8% (n=82,076) underwent postoperative intensive care unit admission; 88.6% (n=72,702) of these received life-support interventions. From 2016 to 2025, intensive care unit admissions declined by 8.4% (95% CI 6.7-10.1), whereas life-support intervention use increased by 24.2% (95% CI 22.8-25.6) (both p<0.001). Life-support intervention use was more frequent among males (59.3% vs 56.9%), patients with comorbidity (53.7% vs 44.8%), and emergency presentations (24.7% vs 17.8%) (all p<0.001). Compared with colorectal cancer, esophageal cancer surgery had the highest odds of life-support intervention use (aOR 2.42, 95% CI 2.16-2.72). Life-support intervention use was associated with prolonged hospitalization (aOR 2.89, 95% CI 2.66-3.14), complications (aOR 1.94, 95% CI 1.85-2.04), 30-day mortality (aOR 2.82, 95% CI 2.50-3.19), and lower odds of discharge home (aOR 0.25, 95% CI 0.23-0.27) (all p<0.001). CONCLUSIONS: After gastrointestinal cancer surgery, intensive care unit use declined while life-support intervention use increased, indicating more selective concentration of higher-acuity postoperative care. Life-support intervention use was strongly associated with adverse short-term outcomes and may serve as a marker of postoperative severity to inform perioperative risk stratification and critical-care resource planning.