{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T11:38:26Z","timestamp":1770982706410,"version":"3.50.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T00:00:00Z","timestamp":1758067200000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:p>With advances made in the care for esophagectomy patients, the need for routine postoperative intensive care unit (ICU) admission needs reassessment. We developed a preoperative prediction model to distinguish patients requiring routine ICU admission from those who can be cared for in a post-anesthesia care unit (PACU).<\/jats:p>\n               <jats:p>This retrospective cohort study included consecutive adults undergoing elective esophagectomy between January 2011 and June 2021 in the UMC Utrecht. Firth\u2019s corrected multivariable logistic regression was used for model development and internal validation using bootstrapping was performed to obtain optimism-corrected performance metrics.<\/jats:p>\n               <jats:p>Among the 619 patients included, 380 (61%) received critical care support beyond the first morning following surgery: 83 (13%) were on invasive mechanical ventilation and 338 (55%) needed cardiovascular support (with 174 [28%] receiving only low-dose norepinephrine). Predictors retained in the final model included age, diabetes mellitus, hemoglobin level, kidney function, forced expiratory volume in 1\u00a0second, tumor stadium, type of neoadjuvant therapy and surgical approach. Discrimination was acceptable (adjusted c-statistic 0.67, 95% CI 0.62\u20130.71) with good calibration (O:E ratio 1.00). Using the model, approximately 50% of ICU beds could be conserved, at the cost of misallocating 22% of patients to a PACU (with only 12% of PACU-allocated patients requiring mechanical ventilation). Between one- and two-thirds of elective esophagectomy patients do not need routine ICU admission, depending on whether hemodynamic support can be provided in another high-dependency unit. Our model can help rationalize perioperative patient allocation and reduce ICU bed claims by roughly half.<\/jats:p>","DOI":"10.1093\/dote\/doaf075","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T23:23:50Z","timestamp":1758324230000},"source":"Crossref","is-referenced-by-count":2,"title":["Judicious use of critical care resources by predicting the need for routine ICU admission following esophagectomy"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2135-2200","authenticated-orcid":false,"given":"Nikki","family":"de Mul","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]},{"name":"Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]},{"name":"Julius Center, University Medical Center Utrecht Universiteitsweg , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisette M","family":"Vernooij","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]},{"name":"Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nynke C J","family":"van Haastregt","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eline M","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Upper Gastro-intestinal Surgery, University Medical Center Utrecht Heidelberglaan , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Willem-Jan M","family":"Schellekens","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]},{"name":"Department of Anesthesiology, Cantonal Hospital Aarau , Aarau ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennie P G","family":"Derde","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jelle P","family":"Ruurda","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Upper Gastro-intestinal Surgery, University Medical Center Utrecht Heidelberglaan , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olaf L","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Heidelberglaan , Utrecht ,","place":["the Netherlands"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,17]]},"reference":[{"key":"2025091919234223000_ref1","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1111\/nyas.13677","article-title":"Surgical treatment of esophageal cancer in the era of multimodality management","volume":"1434","author":"Borggreve","year":"2018","journal-title":"Ann N Y Acad Sci"},{"key":"2025091919234223000_ref2","doi-asserted-by":"crossref","first-page":"E243","DOI":"10.21037\/jtd.2019.10.12","article-title":"Recent advances in defining and benchmarking complications after esophagectomy","volume":"11","author":"Goense","year":"2019","journal-title":"J Thorac 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