Prediction of Postoperative ICU Requirement in Oncologic Surgery

Comparison of ASA, SORT, CACI, and P-POSSUM Scores for Predicting Postoperative Intensive Care Unit Requirement in Patients Undergoing Oncologic Surgery

This prospective observational cohort study aims to compare the performance of commonly used perioperative risk scoring systems in predicting postoperative intensive care unit (ICU) requirement among adult patients undergoing oncologic surgery. Accurate prediction of postoperative ICU admission is essential for optimizing patient safety and efficient allocation of limited critical care resources, particularly in high-risk oncologic surgical populations.

A total of 500 adult patients scheduled for elective or emergency oncologic surgery will be prospectively enrolled at a single tertiary oncology center. Preoperative clinical and demographic data, intraoperative variables, and perioperative characteristics will be recorded using a standardized data collection form. Risk assessment will include the American Society of Anesthesiologists (ASA) Physical Status classification, Surgical Outcome Risk Tool (SORT), Age-adjusted Charlson Comorbidity Index (CACI), Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), Eastern Cooperative Oncology Group (ECOG) performance status, Nutritional Risk Screening 2002 (NRS-2002), and preoperative serum albumin levels.

The primary outcome is the need for postoperative ICU admission within the first 24 hours after surgery. Secondary outcomes include unplanned ICU admission, duration of ICU stay, need for mechanical ventilation, hospital length of stay, and 30-day mortality. The predictive performance of each scoring system will be evaluated using receiver operating characteristic (ROC) analysis and multivariable logistic regression models.

Study Overview

• Status: Recruiting
• Conditions: Neoplasms; Postoperative Complications; Perioperative/Postoperative Complications; Intensive Care Units
• Intervention / Treatment: Other: Risk Assessment Scoring Systems (ASA, SORT, CACI, P-POSSUM, ECOG, NRS-2002)

Detailed Description

Postoperative intensive care unit (ICU) admission represents a critical component of perioperative management, particularly in patients undergoing oncologic surgery who frequently present with advanced age, multiple comorbidities, impaired functional capacity, and increased perioperative risk. Accurate preoperative identification of patients requiring postoperative critical care is essential to improve patient outcomes, optimize perioperative planning, and ensure appropriate allocation of limited ICU resources.

Several perioperative risk assessment tools are routinely used in clinical practice, including the American Society of Anesthesiologists (ASA) Physical Status classification, the Surgical Outcome Risk Tool (SORT), and the Age-adjusted Charlson Comorbidity Index (CACI). However, comparative prospective evidence regarding their ability to predict postoperative ICU requirement remains limited. The Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality and morbidity (P-POSSUM), which incorporates both physiological and operative variables, may provide additional prognostic value beyond traditional preoperative scoring systems. Furthermore, functional status and nutritional condition are increasingly recognized as important determinants of surgical outcomes in oncology patients. Therefore, inclusion of Eastern Cooperative Oncology Group (ECOG) performance status, Nutritional Risk Screening 2002 (NRS-2002), and preoperative serum albumin levels may enhance predictive accuracy.

This study is designed as a single-center prospective observational cohort study enrolling adult patients undergoing elective or emergency oncologic surgery. Eligible patients aged 18 years or older will be consecutively included and followed throughout the perioperative period. Preoperative demographic and clinical characteristics, intraoperative variables, and perioperative management data will be recorded using a standardized data collection system.

The primary objective of the study is to evaluate and compare the predictive performance of ASA, SORT, CACI, P-POSSUM, ECOG performance status, and NRS-2002 scores for postoperative ICU requirement within the first 24 hours after surgery. Secondary objectives include assessment of unplanned ICU admission, mechanical ventilation requirement, ICU length of stay, hospital length of stay, and 30-day mortality.

Predictive performance will be evaluated using receiver operating characteristic (ROC) curve analysis with calculation of area under the curve (AUC) values. Differences between scoring systems will be assessed using appropriate statistical comparison methods, and multivariable logistic regression analysis will be performed to determine independent predictors of postoperative ICU requirement while adjusting for potential confounding variables.

The findings of this study are expected to support evidence-based perioperative risk stratification and contribute to improved clinical decision-making regarding postoperative critical care planning in oncologic surgical patients.

• Study Type: Observational
• Enrollment (Estimated): 500

Contacts and Locations

• Study Contact: Name: Busra Uslu YAMAN; Phone Number: +905068321017; Email: buslu.1995@gmail.com

Study Locations

• Turkey (Türkiye)
  • Ankara, Turkey (Türkiye)
    • Recruiting
    • Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital
    • Contact: Busra Uslu YAMAN

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consists of adult patients (aged 18 and older) who are scheduled to undergo elective or emergency oncologic surgery at a single tertiary oncology training and research hospital. The population includes patients with various types of cancer requiring surgical intervention, where postoperative intensive care unit (ICU) requirement needs to be predicted using clinical risk scoring systems.

Description

Inclusion Criteria:

• Patients aged 18 years and older.
• Patients scheduled for elective or emergency oncologic surgery.
• Patients who are able to provide written informed consent.
• Patients whose data will be analyzed for both planned and unplanned intensive care unit (ICU) admissions.

Exclusion Criteria:

• Patients under 18 years of age.
• Patients requiring continuous ICU follow-up due to a pre-existing critical illness prior to the current surgery.
• Patients who do not provide consent to participate in the study.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Oncologic Surgery Patients; Adult patients (≥18 years) undergoing elective or emergency oncologic surgery at Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital.

Other: Risk Assessment Scoring Systems (ASA, SORT, CACI, P-POSSUM, ECOG, NRS-2002); The study evaluates the predictive performance of various risk scoring systems for postoperative intensive care unit (ICU) requirement in adult patients undergoing oncologic surgery. Preoperative and intraoperative data will be collected to calculate ASA, SORT, CACI, P-POSSUM, ECOG, and NRS-2002 scores. The primary outcome is the need for ICU admission within the first 24 hours postoperatively.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Unplanned Postoperative ICU Admission	The number of participants with an unplanned admission to the ICU within the first 24 hours following oncological surgery.	Up to 24 hours post-surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
30-Day All-Cause Mortality	All-cause mortality is defined as any death, regardless of cause, occurring within 30 days following surgery. Mortality data will be collected from hospital records and verified by follow-up (including telephone contact if required). Both in-hospital deaths and deaths occurring after discharge within the 30-day postoperative period will be included in the analysis.	Up to 30 days post-surgery
Duration of ICU Stay (in Days)	Total number of days spent in the intensive care unit from the date of ICU admission until the date of ICU discharge during the index hospitalization.	From date of ICU admission until the date of ICU discharge, assessed up to 30 days post-surgery.
Number of Participants Requiring Mechanical Ventilation within 24 Hours after Surgery	Mechanical ventilation requirement is defined as the need for invasive ventilatory support within the first 24 hours after surgery. Data will be obtained from anesthesia and postoperative care records.	Up to 24 hours post-surgery
Length of Hospital Stay (in Days)	Total number of days from hospital admission to official hospital discharge.	From the date of hospital admission until the date of hospital discharge, assessed up to 90 days.

Collaborators and Investigators

• Sponsor: Dr Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital

Publications and helpful links

General Publications

• Nates JL, Nunnally M, Kleinpell R, Blosser S, Goldner J, Birriel B, Fowler CS, Byrum D, Miles WS, Bailey H, Sprung CL. ICU Admission, Discharge, and Triage Guidelines: A Framework to Enhance Clinical Operations, Development of Institutional Policies, and Further Research. Crit Care Med. 2016 Aug;44(8):1553-602. doi: 10.1097/CCM.0000000000001856.
• Mukherjee S, Kedia A, Goswami J, Chakraborty A. Validity of P-POSSUM in adult cancer surgery (PACS). J Anaesthesiol Clin Pharmacol. 2022 Jan-Mar;38(1):61-65. doi: 10.4103/joacp.JOACP_128_20. Epub 2022 Apr 25.
• Yildirim M, Halacli B, Kaya EK, Ulusoydan E, Ortac Ersoy E, Topeli A. Prognostic Accuracy of Nutritional Assessment Tools in Critically-Ill COVID-19 Patients. J Clin Med. 2025 May 13;14(10):3382. doi: 10.3390/jcm14103382.

Study record dates

Study Major Dates

• Study Start (Actual): December 15, 2025
• Primary Completion (Estimated): September 15, 2026
• Study Completion (Estimated): November 15, 2026

Study Registration Dates

• First Submitted: February 27, 2026
• First Submitted That Met QC Criteria: April 18, 2026
• First Posted (Actual): April 21, 2026

Study Record Updates

• Last Update Posted (Actual): April 21, 2026
• Last Update Submitted That Met QC Criteria: April 18, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Pathological Conditions, Signs and Symptoms; Neoplasms; Postoperative Complications
• Other Study ID Numbers: 2025-12/193

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data (IPD) will not be shared to ensure patient confidentiality and data privacy, as stated in the ethical committee approval.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No