Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. 926 www.ccmjournal.org May 2016 • Volume 44 • Number 5 Objective: To investigate ICU utilization and hospital outcomes of oncological patients admitted to a comprehensive cancer center. Design: Observational cohort study. Setting: The University of Texas MD Anderson Cancer Center. Patients: Consecutive adults with cancer discharged over a 20-year period. Interventions: None. Measurements and Main Results: The Cochran-Armitage test for trend was used to evaluate ICU utilization and hospital mortality rates by primary service over time. A negative binomial log linear regression model was fitted to the data to investigate length of stay over time. Among 387,306 adult hospitalized patients, the ICU utilization rate was 12.9%. The overall hospital mortality rate was 3.6%: 16.2% among patients with an ICU stay and 1.8% among non-ICU patients. Among those admitted to the ICU, the mean (SD) admission Sequential Organ Failure Assessment score was 6.1 (3.8) for all ICU patients: 7.3 (4.4) for medical ICU patients and 4.9 (2.8) for surgical ICU patients. Hematologic disorders were associated with the highest hospital mortality rate in ICU patients (42.8%); metastatic disease had the highest mortality rate in non-ICU patients (4.2%); sepsis, pneumonia, and other infections had the highest mortality rate for all inpatients (8.5%). Conclusions: This study provides a longitudinal view of ICU utiliza- tion rates, hospital and ICU length of stay, and severity-adjusted mortality rates. Although the data arise from a single institution, it encompasses a large number of hospital admissions over two decades and can serve as a point of comparison for future onco- logical studies at similar institutions. More studies of this nature are needed to determine whether consolidation of cancer care into specialized large-volume facilities may improve outcomes, while simultaneously sustaining appropriate resource utilization and reducing unnecessary healthcare costs. (Crit Care Med 2016; 44:926–933) Key Words: cancer; critically ill; intensive care unit; intensive care unit utilization; outcome; oncologic A n aging population and the projected shortage of criti- cal care providers over the next 25 years underscore the need for the optimal use of critical care resources (1). ICU utilization contributes to a significant portion of health- care costs (2, 3). In 2005, intensive care services accounted for 13.3% of total hospital expenditures and 4.25% of national healthcare expenditures. Although annual costs for critical care services increased by 44.2% between 2000 and 2005, national health expenditures simultaneously decreased by 1.8% (3). Furthermore, the Medicare reimbursement rate for intensive care is only 83% of its costs (4). In 2009, there were 4.7 million cancer-related hospital admis- sions in the United States, with costs reaching $20.1 billion dol- lars (5). Medicare beneficiaries with cancer have shown a higher utilization of healthcare resources than similar patients with- out cancer ($15,605 more per patient) (6). In two large studies encompassing 20 years of data from the Centers for Medicare and Medicaid Services, however, the use of critical care resources by cancer patients could not be determined (2, 3). Recent and impending healthcare and reimbursement reforms may restrict ICU usage (7, 8), despite the continual Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DOI: 10.1097/CCM.0000000000001568 1 Department of Clinical Analytics and Informatics, The University of Texas MD Anderson Cancer Center, Houston, TX. 2 Department of Critical Care, The University of Texas MD Anderson Cancer Center, Houston, TX. 3 Houston Methodist Cancer Center, Houston Methodist Research Institute, Houston, TX. 4 Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center School of Public Health, Houston, TX. 5 Department of Biostatistics, The University of Texas Health Science Center School of Public Health, Houston, TX. Drs. Waller, Piller, and Tilley received funding from the University of Texas School of Public Health (they are paid a salary as faculty members and part of their duties are to serve as an adviser to doctoral students and were on the advisory committee for the first author). The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Joseph L. Nates, MD, MBA, The Univer- sity of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 112, Houston, TX 77030. E-mail: jlnates@mdanderson.org Two Decades of ICU Utilization and Hospital Outcomes in a Comprehensive Cancer Center Susannah K. Wallace, PhD 1 ; Nisha K. Rathi, MD 2 ; Dorothy K. Waller, PhD 4 ; Joe E. Ensor Jr, PhD 3 ; Sajid A. Haque, MD 2 ; Kristen J. Price, MD 2 ; Linda B. Piller, MD, MPH 4,5 ; Barbara C. Tilley, PhD 5 ; Joseph L. Nates, MD, MBA 2