TY - JOUR
T1 - A comparison of very old patients admitted to intensive care unit after acute versus elective surgery or intervention
AU - Jung, Christian
AU - Wernly, Bernhard
AU - Muessig, Johanna M.
AU - Kelm, Malte
AU - Boumendil, Ariane
AU - Morandi, Alessandro
AU - Andersen, Finn H.
AU - Artigas, Antonio
AU - Bertolini, Guido
AU - Cecconi, Maurizio
AU - Christensen, Steffen
AU - Faraldi, Loredana
AU - Fjølner, Jesper
AU - Lichtenauer, Michael
AU - Bruno, Raphael Romano
AU - Marsh, Brian
AU - Moreno, Rui
AU - Oeyen, Sandra
AU - Öhman, Christina Agvald
AU - Pinto, Bernadro Bollen
AU - Soliman, Ivo W.
AU - Szczeklik, Wojciech
AU - Valentin, Andreas
AU - Watson, Ximena
AU - Zafeiridis, Tilemachos
AU - De Lange, Dylan W.
AU - Guidet, Bertrand
AU - Flaatten, Hans
N1 - Copyright © 2019 Elsevier Inc. All rights reserved.
PY - 2019/1
Y1 - 2019/1
N2 - © 2019 Elsevier Inc. 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.
AB - © 2019 Elsevier Inc. 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.
KW - Critically ill
KW - Elective
KW - Frailty
KW - Old
KW - Older
KW - Outcome
UR - http://www.mendeley.com/research/comparison-very-old-patients-admitted-intensive-care-unit-after-acute-versus-elective-surgery-interv
U2 - 10.1016/j.jcrc.2019.04.020
DO - 10.1016/j.jcrc.2019.04.020
M3 - Article
C2 - 31055187
SN - 0883-9441
VL - 52
SP - 141
EP - 148
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -