A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention

J Crit Care. 2019 Aug;52:141-148. doi: 10.1016/j.jcrc.2019.04.020. Epub 2019 May 2.

Abstract

Background: We aimed to evaluate differences in outcome between patients admitted to intensive care unit (ICU) after elective versus acute surgery in a multinational cohort of very old patients (≥80 years; VIP). Predictors of mortality, with special emphasis on frailty, were assessed.

Methods: In total, 5063 VIPs were included in this analysis, 922 were admitted after elective surgery or intervention, 4141 acutely, with 402 after acute surgery. Differences were calculated using Mann-Whitney-U test and Wilcoxon test. Univariate and multivariable logistic regression were used to assess associations with mortality.

Results: Compared patients admitted after acute surgery, patients admitted after elective surgery suffered less often from frailty as defined as CFS (28% vs 46%; p < 0.001), evidenced lower SOFA scores (4 ± 5 vs 7 ± 7; p < 0.001). Presence of frailty (CFS >4) was associated with significantly increased mortality both in elective surgery patients (7% vs 12%; p = 0.01), in acute surgery (7% vs 12%; p = 0.02).

Conclusions: VIPs admitted to ICU after elective surgery evidenced favorable outcome over patients after acute surgery even after correction for relevant confounders. Frailty might be used to guide clinicians in risk stratification in both patients admitted after elective and acute surgery.

Trial registration: NCT03134807. Registered 1st May 2017.

Keywords: Critically ill; Elective; Frailty; Old; Older; Outcome.

Publication types

  • Clinical Trial
  • Comparative Study
  • Multicenter Study

MeSH terms

  • Acute Disease
  • Aged, 80 and over
  • Cohort Studies
  • Critical Care / statistics & numerical data*
  • Elective Surgical Procedures / mortality
  • Elective Surgical Procedures / statistics & numerical data*
  • Female
  • Frail Elderly / statistics & numerical data*
  • Frailty / mortality
  • Frailty / surgery*
  • Hospital Mortality
  • Hospitalization / statistics & numerical data*
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Logistic Models
  • Male
  • Postoperative Care / statistics & numerical data
  • Prospective Studies
  • Wounds and Injuries / mortality
  • Wounds and Injuries / surgery

Associated data

  • ClinicalTrials.gov/NCT03134807