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

Acute Disease Aged, 80 and over Cohort Studies Critical Care / statistics & numerical data Elective Surgical Procedures / mortality Female Frail Elderly / statistics & numerical data Frailty / mortality 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

Critically ill Elective Frailty Old Older Outcome

Journal

Journal of critical care

ISSN: 1557-8615

Titre abrégé: J Crit Care

Pays: United States

ID NLM: 8610642

Informations de publication

Date de publication:
08 2019

Historique:

received: 27 11 2018

revised: 04 04 2019

accepted: 18 04 2019

pubmed: 6 5 2019

medline: 25 7 2020

entrez: 6 5 2019

Statut: ppublish

Résumé

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. 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. 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). 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. NCT03134807. Registered 1st May 2017.

Sections du résumé

BACKGROUND

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.

Identifiants

DOI: 10.1016/j.jcrc.2019.04.020 PMID: 31055187

pubmed: 31055187

pii: S0883-9441(18)31692-7

doi: 10.1016/j.jcrc.2019.04.020

pii:

doi:

Banques de données

ClinicalTrials.gov

['NCT03134807']

Types de publication

Clinical Trial Comparative Study Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

141-148